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Transforming Risk Adjustment Through Insight, Transparency and Control
Transforming Risk Adjustment Through Insight, Transparency and Control
Transforming Risk Adjustment Through Insight, Transparency and Control
Call us today 855.984.1775
12 Jul

2017 EDGE Submission Preparation

As we approach the start of the 2017 EDGE submission season, there are some required tasks that CMS will be asking the plans to perform, as well as some that plans can do to be ahead of the game. First, this month, CMS will be initiating the “archive process” – moving the 2016 database schemas to the side and creating the new 2017 schemas. As always, all of the old submission year schemas and data are still available for querying. Once that process is completed, the first baseline/submission deadline will most likely be at the end of October/beginning of November. Until then, Babel recommends that plans review their baseline and submission process for gaps and identify inefficiencies that could reduce cost or improve accuracy.

Here are some things to think about along with some preparation suggestions:

Team/Partner: Do you still have the right team and partners? Can you draw on the right expertise at the right time, from the first submission through the final deadline near the end of April 2018? Have your vendors changed any file formats or processes for 2017?

Baseline process: Babel recommends using methods of assessing the baseline numbers that are separate and distinct from the extraction process in order to identify potential accuracy problems early. For example, if the plan extracts claims and enrollment using a proprietary program, then develop independent SQL queries to calculate the baseline numbers. Before the first deadline in 2017, do a test extraction, calculate a set of test baseline numbers and ensure that the numbers are in sync.

Extraction process: Are there changes in the core 2017 claims processing that will affect how new claims and adjustments are extracted?

Error correction process: Are you prioritizing errors by risk, revenue, and/or cost? What’s the single most expensive part of this process that could be streamlined?

IT: Are there other costs that could be reduced? Perhaps it’s moving files manually, or experiencing slowdowns due to ineffective or non-existent tooling.

To help with planning, here are the known and anticipated dates for 2017 and early 2018:

July 10th – 24th: Archive Process
July 10th: CEO Designates receive email with link to pre-archive confirmation web-form
July 10th – 14th: perform pre-archive steps, confirm completion via web-form
July 24th: CEO Designate receives email with link to archive confirmation web-form
July 24th – 28th: perform archive steps, confirm completion via web-form
July 31st (tentative): production zone blackout lifted
Sept (middle): submit plan templates and corrections
Nov (beginning): submit baselines Q1 and Q2, then submit data
Dec (beginning): submit baselines Q1-Q3, then submit data
Jan (end): deadline for interim RA calculation
Feb (end), March (beg): Q1-Q4 baseline and submission
Apr (end) final submission

If you haven’t seen it already, the 2016 Transfer Payment report has been released and can be downloaded from the CMS site. The links are:
Summary Report on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2016 Benefit Year [PDF, 1MB]  
Appendix A to June 30, 2017 Summary Report – HHS Risk Adjustment Program State-Specific Data [XLSX, 28KB]
Appendix B to June 30, 2017 Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF ) [XLSX, 80KB]
Appendix C to June 30, 2017 Summary Report – Table 4: Issuer Specific Information [XLSX, 51KB]
Appendix D to June 30, 2017 Summary Report – Table 5: Issuer-Specific Information for Vermont Issuers [XLSX, 10KB]
Appendix E to June 30, 2017 Summary Report – Table 8: Default Risk Adjustment Charge [XLSX, 11KB]
Appendix F to June 30, 2017 Summary Report – Table 9: Default Charge Allocation [XLSX, 20KB]

Gretchen Adin