Risk adjustment is the process by which the Centers for Medicare & Medicaid Services (CMS) reimburses Medicare Advantage plans, based on the health status of their members. Risk adjustment was implemented to pay Medicare Advantage plans more accurately for the predicted health cost expenditures of members by adjusting payments based on demographics (age and gender) as well as health status.


In 2020, Anthem and AMH Health, LLC will work with Optum, who is working with Ciox Health, to request medical records with dates of service for the target year 2019 through present day.


Jaime Marcotte, Medicare Retrospective Risk Program Lead, is managing this project. If you have any questions regarding this program, please contact Jaime at jaime.marcotte@anthem.com or


Additional information, including an FAQ, will be available on the provider website at Important Medicare Advantage Updates.




Featured In:
June 2020 Anthem Maine Provider News