Common use of Risk Adjustment Appeals Clause in Contracts

Risk Adjustment Appeals. The MCO may appeal to the STATE the following quarter’s risk factor. Any appeal of risk factors must be filed with the STATE within two weeks of notification of the new risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’S risk factor based on encounter data submitted in a timely manner.‌

Risk Adjustment Appeals. The MCO may appeal to the STATE the following quarter’s risk factor. Any appeal of risk factors must be filed with the STATE within two weeks of notification of the new risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’S ’s risk factor based on encounter data submitted in a timely manner.‌manner as required by section 3.5.1.‌

Risk Adjustment Appeals. The MCO may appeal risk factors to the STATE the following quarter’s risk factorSTATE. Any appeal of risk factors must be filed with the STATE within two six weeks of notification of the new risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’S ’s risk factor based on encounter data submitted in a timely manner.‌manner. The risk score appeal must contain a succinct explanation of why the MCO finds the scores incorrect, with supporting data sufficient to allow the STATE to evaluate the appeal in a timely fashion.

Risk Adjustment Appeals. The MCO may appeal to the STATE the following quarter’s risk factor. Any appeal of risk factors must be filed with the STATE within two weeks of notification of the new risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’S ’s risk factor based on encounter data submitted in a timely manner.‌manner as required by section 3.5.1.

Risk Adjustment Appeals. The MCO may appeal to the STATE the following quarter’s risk factor. Any appeal of risk factors must be filed with the STATE within two six weeks of notification of the new risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’S ’s risk factor based on encounter data submitted in a timely manner.‌manner as required by section 3.5.1.

Risk Adjustment Appeals. The MCO may appeal to the STATE the following quarter’s risk factor. Any appeal of risk factors must be filed with the STATE within two weeks of notification of the new risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’S risk factor based on encounter data submitted in a timely manner.‌manner.