Analyze, Design, Maintain and Provide Implementation Instructions for a Modification of the Part A and Part B Common Edits and Enhancement Modules (CEMs), to allow 277C Edits to be Turned On/Off by the Encounter Data Front-End System (EDFES) Contractor Only
CMS will collect and price Medicare Advantage (MA) Plan encounter data to establish risk adjustment models based on MA cost and utilization. The data will be collected from the MA Plans in the 837X Version 5010 format. The MA Plans will submit adjudicated data which will be processed using the Medicare Encounter Data Processing and Pricing System based on modified versions of the Medicare Fee for Service (FFS) claims processing systems. The Encounter Data Front End System (EDFES) will use a version of the Part A and the Part B Common Edit and Enhancement Modules (CEMs) to edit MA encounter data.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: March 04, 2011
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