Risk Adjustment Model Sample Clauses
Risk Adjustment Model. The CDPS + Rx model will be used. In general, the most recent available version of the model will be applied, though there may be circumstances in which an older version is preferred. Concurrent weights will be used to develop the risk profiles of enrollees. ICD-9 based risk models will be applied until such time as ICD-10 based diagnosis codes are available in the claims data. There may be a period of time when diagnosis codes need to be mapped from one system to the other in order to apply the risk adjustment models.
Risk Adjustment Model. For the prospective member mix, we will continue to employ MEMA. This methodology adjusts the NFLOC capitation rates based on a MCOP’s mix of nursing facility and Community Waiver membership.