Risk Adjustment Data Sample Clauses
The 'Risk Adjustment Data' clause defines the requirements and procedures for collecting, submitting, and maintaining data used for risk adjustment purposes in healthcare contracts. Typically, this clause outlines the types of data that must be provided, such as patient diagnoses and treatment information, and sets standards for accuracy, timeliness, and compliance with regulatory guidelines. By establishing clear expectations for data handling, the clause ensures that risk adjustment calculations are based on reliable information, which is essential for fair payment distribution and regulatory compliance in managed care arrangements.
Risk Adjustment Data. The MA Organization agrees to comply with the requirements in §422.310 for submitting risk adjustment data to CMS. [422.504(a)(8)]
Risk Adjustment Data. This data will be shared quarterly and will include, for the relevant Performance Year:
(i) The risk scores established in accordance with Appendix B and the demographic information specified in the Reporting and Data Sharing Overview for REACH Beneficiaries; and
(ii) The risk scores established in accordance with Appendix B and the demographic information specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for the period prior to the date the Beneficiary was removed from alignment to the ACO.
Risk Adjustment Data. All data that is used in the application of a risk adjustment payment model.
Risk Adjustment Data. Provider's Risk Adjustment Data shall include all information necessary for Plan to submit such data to CMS as set forth in 42 CFR § 422.310 or any subsequent or additional regulatory provisions. If Provider fails to submit his/her/its Risk Adjustment Data accurately, completely and truthfully, in the format described in the 42 CFR § 422.310 or any subsequent or additional regulatory provisions, then this will result in denials and/or delays in payment of Provider's Claims.
Risk Adjustment Data. This data will be shared quarterly and will include, for the relevant Performance Year:
(i) The risk scores established in accordance with Appendix B and the demographic information specified in the Reporting and Data Sharing Overview for DC Beneficiaries; and
(ii) The risk scores established in accordance with Appendix B and the demographic information specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for the period prior to the date the Beneficiary was removed from alignment to the DCE.
Risk Adjustment Data. Provider's Risk Adjustment Data shall include all information necessary for or requested by Plan to enable Plan to submit such data to CMS as set forth in 42 CFR § 422.310 or any subsequent or additional regulatory provisions or CMS guidance. If Provider fails to submit accurate, complete, and truthful Risk Adjustment Data in the format described in 42 CFR § 422.310 or any subsequent or additional regulatory provisions or CMS guidance, then this may result in denials and/or delays in payment of Provider's Claims. Plan will make best efforts to work with Provider to resolve Risk Adjustment Data format and/or processing issues.
Risk Adjustment Data. This data will include DC Beneficiaries' risk scores.