Medicare Advantage – Risk Adjustment Data Submission & Analytics

Closing Care Gaps. Maximizing Reimbursement. Staying CMS-Compliant.

For Medicare Advantage (MA) plans, success depends on accurate risk adjustment data submissions and smart analytics. CMS requires encounter data (EDS) submissions through the MARx and Encounter Data System, and even small errors can mean missed reimbursement opportunities.

That’s where Health Data Max comes in.

End-to-End Risk Adjustment Submission Support

At Health Data Max, we:

  • Ingest and validate your claims and encounter data

  • Certify submissions to the CMS MARx Portal on your behalf

  • Track every stage of the submission pipeline:

    • 999s (acknowledgement)

    • 277CAs (status)

    • MAO-002s (encounter feedback)

    • MAO-004s (risk adjustment reports)

    • MORs/MMRs (monthly membership & risk adjustment reports)

With our platform, you always have a complete picture of your submission status—at your fingertips.

Advanced Risk Adjustment Analytics

Our analytics engine doesn’t stop at submission. Post-submission, we generate insights that matter:

  • Risk Scores by Member & Provider
    Evaluate provider performance and member-level RAF scores using CMS-HCC risk models.

  • High-Chronic Patient Reporting
    Identify the top 3% of chronic patients who typically drive up to 50% of costs—and close their care gaps first.

  • Submission Error Prioritization
    Detect the most common coding and file errors, and correct them at the source for higher CMS acceptance rates.

  • Quality & Care Gap Tracking
    Spot preventive and chronic care gaps in real time to improve Stars performance and patient outcomes.

Why Health Data Max?

  • Maximized Reimbursement → Accurate RAF capture, cleaner CMS acceptance, and minimized revenue leakage.

  • Compliance-First → Fully aligned with CMS encounter data submission requirements.

  • Actionable Visibility → Provider-level dashboards to track coding accuracy, care gap closure, and chronic condition documentation.

  • Smarter Focus → Redirect time from error-chasing to improving patient care.

In Medicare Advantage, precision is everything. The plans that master risk adjustment data submissions—and act on analytics—lead in both compliance and revenue.

[Contact Us Today] to learn how HDM can simplify your EDS submissions and unlock deeper insights.