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In 2014, the federal government will reimburse health plans based on the health of their members, similar to the way Medicare Advantage plans are reimbursed today. This reimbursement will be determined through a method used by the Centers for Medicare and Medicaid Services (CMS) called "risk adjustment."
You play an important role in the risk adjustment process because your claims coding data will be used to indicate the complete picture of health for our members. This same data will also enable us to plan, analyze and design programs to help manage members' chronic conditions.
View our Coding and Documentation Improvement Initiative resources and tools below to learn more about risk adjustment and how you can provide the most accurate, complete coding and documentation possible.
Coding Guides for the following conditions are available through ProviderAccess:
These Coding Guides include specific chronic diagnosis codes and were created primarily for Blue Cross and Blue Shield of Alabama's Blue Advantage (PPO) Primary Care Incentive Program. However, these guides may be helpful with meeting criteria for our Complete Picture of Health Documentation and Coding Improvement Initiative.
As announced in ProviderFacts 2013-013, coding profile reports with valuable information from claims data are also available through ProviderAccess. Look for these reports under Provider Profile Information and Reporting.