Modify the Interchange Control Number (ICN) for Medicare Advantage Encounters
Currently Medicare Advantage (MA) plans submit data in an abbreviated claims format to CMS to provide the diagnostic information used in calculating the health status component of the beneficiary risk scores, which is used as the basis for the MA plan payment. MA plans do not currently submit information on each encounter and do not submit most elements included in the ANSI 5010 format, such as Current Procedural Terminology (CPT) codes that might be used to calculate a Fee-ForService (FFS) payment. Therefore, CMS uses FFS data to determine beneficiary utilization patterns to predict costs in the MA program.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 27, 2011
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