Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: April 18, 2016

Program Area: Vendor Management, Payments, and Collections (VMPC)

Question: How do Issuers identify Risk Adjustment (RA) payments in the Preliminary Payment Report (PPR) and HIX 820 Transaction?

Answer: On the PPR, the RA program type is displayed in Excel in Column K (Exchange Payment Type). The invoice number (where the first letter of the invoice number is used to determine the market) for RA transactions is displayed in Excel in Column N (Exchange Report Document Control Number). Issuers will also see the exchange related report type code RARPT in Column R. On the HIX 820, the RA program type is displayed in the Exchange Payment Code field and the invoice number is displayed in the Document Control Number field. For RA transactions, the markets designations are as follows: I (Individual) L (Small Group) T (Catastrophic) M (Merged) For definitions of other payment type codes, please reference the Washington Publishing website at www.wpc-edi.com.

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