Understanding the Model Output Report (MOR): A Vital Tool in Medicare Advantage Risk Adjustment

In the world of Medicare Advantage (MA), where accurate payment depends on the health risk of enrollees, precision in data reporting is not optional—it's fundamental. At the heart of CMS’s risk adjustment process lies the Model Output Report (MOR). This document is a vital feedback mechanism that informs Medicare Advantage Organizations (MAOs) how CMS is interpreting submitted diagnosis data and applying it to calculate risk scores. 

This blog explores everything you need to know about the MOR 

🔍 What is the Model Output Report (MOR)? 

The Model Output Report is a monthly report generated by CMS for each contract, showing which Hierarchical Condition Categories (HCCs) and demographic variables have been used to compute each enrollee’s risk score. These scores directly affect the payments made to MA plans. 

The MOR exists in two formats: 

  • MOR Report – A human-readable summary of beneficiary risk factors 

  • MOR Data File – A flat file optimized for automated processing by plan systems 

Together, they provide a detailed view into how CMS has interpreted diagnosis data to arrive at specific HCC assignments. 

📅 Frequency and Timing of Reports 

CMS typically runs the risk adjustment model three times per year: 

  1. Initial 

  2. Mid-Year 

  3. Final 

Each run produces updated risk scores and MORs. The monthly MORs reflect the most recent model run, unless a new run has occurred. For example, January through June payments are based on the Initial model run, while July through December are based on the Mid-Year run. 

🗂️ MOR File Components 

📄 Report Format 

The report is structured for human review and includes: 

  • Contract ID 

  • Run date 

  • Payment month/year 

  • Beneficiary ID, name, DOB, sex, ESRD indicator 

  • Assigned HCCs from RAPS or Encounter Data (record types D or I) 

  • Indicators of data source and model version (e.g., V22, V23) 

📁 Data File Format 

The flat file version is designed for systems to process: 

  • 200-byte records (Part C), 168–180 bytes (Part D) 

  • Binary flags indicating presence or absence of each HCC 

  • Demographic switches (e.g., gender, age group, ESRD) 

Each record type maps to a specific model version (e.g., CMS-HCC V24, RxHCC) and data source. 

🔍 Diagnoses and HCC Mapping 

Diagnoses are submitted to CMS in 837 Encounter Data format 

Each diagnosis is mapped to a Condition Category (CC), and CCs are grouped into Hierarchical Condition Categories (HCCs). In each hierarchy, only the most severe condition is counted for risk scoring. 

A diagnosis will appear on the MOR only if: 

  • It maps to a payment HCC 

  • It was submitted within the relevant service date window 

  • It wasn't superseded or deleted 

  • It wasn’t excluded due to a more severe condition in the same hierarchy 

🧠 Why a Diagnosis Might Be on MAO-004 but Missing in MOR 

The MAO-004 file lists all accepted diagnoses, while the MOR filters for only payment-relevant HCCs. Here's why a diagnosis might be missing from the MOR: 

  • The diagnosis doesn't map to a payment HCC 

  • A more severe condition in the same hierarchy overrides it 

  • The encounter was deleted or replaced before the risk score run 

🗃️ Accessing MOR Files 

MOR files are distributed via: 

  • MARx User Interface (UI) 

  • EFT Mailbox (Gentran, TIBCO, Connect:Direct) 

Naming conventions follow this format: 

  • For Report(HCCMODR): 

P.Rxxxxx.HCCMODR.Dyymm01.Thhmmsst 

  • For Data File (HCCMODD): 

P.Rxxxxx.HCCMODD.Dyymm01.Thhmmsst 

Where: 

  • xxxxx is your contract ID 

  • yy/mm is year/month of the payment period 

  • hhmmss is timestamp 

Archived MORs can be ordered through the CMS Enterprise Portal. 

🧮 Why MOR Matters 

The MOR isn’t just a compliance artifact. It’s your primary validation tool for ensuring that the risk scores CMS is using: 

  • Align with your internal HCC projections 

  • Reflect accurate submission 

  • Provide transparency into CMS’s interpretation of your data 

Used effectively, it can drive better forecasting, error resolution, and audit preparation. 

📌 Final Thoughts 

The Model Output Report bridges your internal data and CMS’s final risk scoring methodology. It’s the only direct window into which HCCs made it into payment and why. For Medicare Advantage plans, understanding the MOR means being equipped to audit, reconcile, and defend your risk adjustment strategy. 

At HealthDataMax, we help MAOs automate, decode, and act on MOR data, making sure your plan isn’t just CMS-compliant, but CMS-optimized. 

Need help interpreting your MOR or aligning your encounter data with CMS models? 

 📩 Reach out to our team at HealthDataMax to learn how we can support your risk adjustment operations.