Common use of Risk Adjustment Appeals Clause in Contracts

Risk Adjustment Appeals. The MCO may appeal the STATE’s calculation of the MCO’s risk scores upon notification that risk scores will change. Any appeal of risk scores must be filed with the STATE within six weeks of notification of the risk scores. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’s risk scores based on encounter data submitted in a timely manner as required by section 3.

Risk Adjustment Appeals. ‌ The MCO may appeal the STATE’s calculation of the MCO’s risk scores upon notification that risk scores will change. Any appeal of risk scores factors must be filed with the STATE within six weeks of notification of the new risk scores. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’s risk scores factor based on encounter data submitted in a timely manner as required by section 3manner. 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.

Risk Adjustment Appeals. ‌‌‌ The MCO may appeal the STATE’s calculation of the MCO’s risk scores upon notification that risk scores will change. Any appeal of risk scores factors must be filed with the STATE within six weeks of notification of the new risk scores. The basis for any appeal by the MCO under this section shall be limited to whether or not the STATE correctly calculated the MCO’s risk scores factor based on encounter data submitted in a timely manner as required by section 3manner. 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.