2020 Supplemental Claims Impact

Risk score capture and accuracy through supplemental claims continues to be an industry hot topic. Supplemental files allow issuers to ensure accurate coding for risk scoring, thus impacting risk adjustment transfers in the ACA market. In addition, supplemental files also help issuers mitigate risk adjustment data validation (RADV) audit risk for both “under-coding” and “over-coding” by correcting data within their claims system.

This paper provides information related to supplemental claim information collected through the Wakely National Risk Adjustment Reporting (WNRAR) project. The average impact of supplemental data to risk scores and industry insights are provided in the paper.