Importance of timely submission of Medicare risk adjustment data

Blue Medicare Advantage (BMA) receives member diagnosis data via traditional claims and encounters submissions as well as an alternate submission method (ASM). Member diagnosis data submitted through the ASM are submitted as a supplemental data file and are intended to support, enhance, and/or correct member diagnosis information for previously submitted claims or encounters. They are not intended to be the sole source of diagnosis information or to be used as an alternative to the standard claim or encounter submission. 

Medicare Advantage organizations are required to submit member diagnosis data reported by our care provider partners or their provider organizations to CMS for Medicare risk adjustment (MRA) purposes. It is critical that claims, encounters, and supplemental data files be submitted promptly and in advance of the CMS deadlines for submission of MRA diagnosis data. Also, BMA has established separate guidelines to help our care provider partners and their provider organizations meet their obligations for timely submission of MRA diagnosis data. These timeframes will help ensure that there is adequate time for processing, including error resolution and submission of MRA data to CMS.

The table below represents the applicable submission timeframes for different MRA risk score cycles. There are typically three risk score cycles for each submission period: Initial, mid-year, and final. The submission periods for the initial and mid-year risk score cycles have been completed for 2023; therefore, the submission deadlines are not displayed in the table below. With your help, we can continually build towards a future of shared success.