Common use of EW Risk Adjustment Appeals Clause in Contracts

EW Risk Adjustment Appeals. ‌ The MCO may appeal to the STATE the following year’s risk score. Any appeal of risk scores must be filed with the STATE within six weeks of notification of the risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly

EW Risk Adjustment Appeals. ‌ The MCO may appeal to the STATE the following year’s risk score. Any appeal of risk scores must be filed with the STATE within six weeks of notification of the risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctlycorrectly calculated the MCO’s risk score based on encounter data submitted in a timely manner as

EW Risk Adjustment Appeals. ‌ The MCO may appeal to the STATE the following year’s risk score. Any appeal of risk scores must be filed with the STATE within six weeks of notification of the risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctlycorrectly calculated the MCO’s risk score based on encounter data submitted in a timely manner as required by section 3.7.1. The risk score appeal must contain a succinct explanation of why the MCO finds the scores incorrect, with supporting data sufficient to allow the STATE to evaluate the appeal in a timely fashion.

EW Risk Adjustment Appeals. ‌ The MCO may appeal to the STATE the following year’s (proposed) risk scorefactors. Any appeal of risk scores factors must be filed with the STATE within six weeks of notification of the new proposed risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctlycorrectly calculated the MCO’s risk factor based on encounter data submitted in a timely manner as required by section 3.7.1.

EW Risk Adjustment Appeals. ‌ The MCO may appeal to the STATE the following year’s risk score. Any appeal of risk scores must be filed with the STATE within six weeks of notification of the risk factors. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctlycorrectly calculated the MCO’s risk score based on encounter data submitted in a timely manner as required by section 3.7.1. The risk score appeal must contain a succinct explanation of why the MCO finds the scores incorrect, with supporting data sufficient to allow the STATE to evaluate the appeal in a timely fashion.‌