CMS Pub. 100-16, ch. 7, § 120.2

The following outlines the flow of risk adjustment data:

• Hospital/Physician submits data to MA organization using standard claims formats,

or through review of medical records.

• The MA organization submits required data at least quarterly to FERAS via Direct

Data Entry (DDE) or RAPS format.

• FERAS checks the file-level data, batch-level data, and first and last detail records on

each Batch Record within the file.

• If any data are rejected, the rejections are reported on the FERAS Response Report.

• After passing the FERAS checks, the file is submitted to RAPS where detail editing is

performed and applicable reports are generated.

• The RAPS Return File contains the entire submitted transaction and identifies errors.

• The RAPS Transaction Error Report communicates errors found in CCC records

during processing.

• The RAPS Transaction Summary Report summarizes the disposition of the diagnosis

clusters.

• The Duplicate Diagnosis Cluster Report identifies diagnosis clusters with the 502-error message. Duplicate clusters are accepted but not stored.

• The RAPS Monthly Plan Activity Report and Cumulative Plan Activity Report

provides a summary of the status of submissions by submitter ID and plan number.

• Distributed monthly and quarterly, the Error Frequency Report provides an overview

of all errors associated with files submitted in test and productions.

• RAPS database stores all finalized diagnosis clusters.

• RAS calculates the Risk Adjuster Factors by executing the CMS-HCC model.

• MARx is used in the calculation of payments and determination of plan payments.