Risk Adjustment

AHIP – Medicare, Medicaid, & Duals Speaking Session

In this new Risk Adjustment world where EDS (Encounter Data System) is quickly replacing the RAPS (Risk Adjustment Processing System), it is integral that Health Plans, Providers, and Groups partner together to overcome a vast array of new problems. Under EDS, CMS has significantly increased the complexity of the data necessary for submission for risk adjustment and payment purposes. This session is intended to help health plans, providers and groups navigate this complexity and provides strategies on how to better partner with each other.

Specifically, the discussion focuses on how to understand and work with the large amount of rejections, how to drive value from the MAO-004 (i.e. EDS version of accepted Dx codes for Risk Adjustment), and what additional compliance and related RADV risks the industry needs to be concerned with. Viewers will learn how to prepare for this new EDS world, and what they need to be doing today in order to be successful tomorrow.


-Tim Spaeth (Episource) – Senior Vice President, Payer Solutions

-David Meyer (SCAN Health Plan) – Vice President, Healthcare Informatics


We simplify the management of member programs by making it radically more efficient, and increasing value to healthcare organizations and their members

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider