New information for Security Health Plan providers
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Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997
More about risk adjustment and HCC coding
- model identifies individuals with serious or chronic illness assigns a risk factor score to the person based upon a combination of the individual's health conditions and demographic details
- The individual's health conditions are identified via International Classification of Diseases-10 (ICD-10) diagnoses that are submitted by providers on incoming claims
- There are more than 9,000 ICD-10 codes that map to 79 HCC codes in the Risk Adjustment model
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