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Claims Linking in CY2027: What Plans Need to Know About the Unlinked Chart Review Exclusion

Webinar

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Beginning with CY2027 payments, CMS will no longer use diagnoses from chart review records that are not linked to an encounter when calculating Medicare Advantage risk scores. For many plans, this changes how chart review findings move from the medical record to submission, and it raises a practical question: what does it take to connect a coded diagnosis to the right claim?

In this session, Chad Wege, Vice President of Risk Adjustment Products at Datavant, walks through what claims linking is, how a single diagnosis is evaluated against a member's claims, and where data completeness, timing, and payment arrangements affect results. He will also cover where CMS has not yet provided standard guidance and the questions plans should be preparing for ahead of CY2027 submissions.

 

Topics at a Glance

  • What the CY2027 Rate Announcement changes for chart review diagnoses, including the exception for members who changed Medicare Advantage organizations.

  • What claims linking is: connecting a diagnosis found in chart review to a claim for the same member and date of service, with provider match as supporting evidence.

  • A step-by-step example of how one diagnosis is evaluated against a member's claims, with the match evidence (eligibility, date of service, and provider) shown for the plan's review.

  • Data realities that affect linking, including claims completeness, claim timing, and capitated arrangements.

  • Where CMS has not yet provided standard guidance on linking, and what to watch next.

 

Who Should Attend

  • Risk adjustment leaders (VP, Director, Manager of Risk Adjustment)

  • Encounter data and submissions teams

  • Risk adjustment coding, quality, and compliance leaders

  • Medicare Advantage finance and actuarial teams

  • Data and IT teams that manage claims and encounter data

 

Top Reasons to Attend

  • Understand what the CY2027 exclusion of unlinked chart review diagnoses means for Medicare Advantage risk scores.

  • See a step-by-step example of how a diagnosis is linked to a claim.

  • Learn which data gaps can keep a diagnosis from linking.

  • Identify the questions to raise with your internal teams before CY2027 submissions.

  • Hear where CMS guidance remains open and what plans should watch for next.

Speakers

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