Ursa Health HCC/RAF Module Terms

CMS-HCC Age Category

A categorical value describing the patient's age with respect to the age ranges used to group patients for the CMS-HCC RAF score calculation; uses the CMS-HCC Patient Age value.

Linked Terms: CMS-HCC Patient Age

CMS-HCC Eligibility Code

The coded value used by the CMS-HCC model to characterize the patient's community vs. long-term institutional residential status, full dual vs. partial dual vs. non-dual status, and aged vs. disabled Medicare eligibility status. Values are as follows: CFA = Community Full Benefit Dual Aged; CFD = Community Full Benefit Dual Disabled; CNA = Community Non-Dual Aged; CND = Community Non-Dual Disabled; CPA: Community Partial Benefit Dual Aged; CPD = Community Partial Benefit Dual Disabled; INS = Long Term Institutional; NE = New Enrollee; SNPNE = SNP NE. Derived, when possible, from the CMS RAF Type Code (obtained either from an MMR record or a membership record). Because the model requires this code as an input, patients are assumed to be CNA if their true status is not known.

Linked Terms: CMS RAF Type Code

Linked Value Sets: LTI STATUS (URSA-HCC CMS_RAF_TYPE_CODE), NEW ENROLLEE STATUS (URSA-HCC CMS_RAF_TYPE_CODE), FULL DUAL STATUS (URSA-HCC CMS_RAF_TYPE_CODE), PARTIAL DUAL STATUS (URSA-HCC CMS_RAF_TYPE_CODE)

CMS-HCC Eligibility Code Description

The natural language description of the CMS-HCC Eligibility Code.

Linked Terms: CMS-HCC Eligibility Code

CMS-HCC ICD-10-CM Code

The ICD-10-CM code on a qualifying diagnosis document type record, formatted for use as an input to the CMS-HCC model (i.e., with the decimal point removed).

CMS-HCC Missing Output Code and Description

The code (e.g., "HCC110") and description (e.g., "Cystic Fibrosis") of a CMS-HCC model output that was, as of a reference date or period, produced by the CMS-HCC model run under the Historical-Diagnoses scenario but not produced under the Within-Year-Updated scenario.

CMS-HCC Missing Output Raw RAF Score Contribution

The raw (i.e., pre-normalization) contribution to the RAF score of the model output listed in the CMS-HCC Missing Output Code and Description field. Useful for ranking the missing diagnoses for a cohort of patients in order to direct an operational team's attention to the most important omissions. Note that the raw score might be meaningfully different from the final effective contribution of any given model output after normalization, and that, e.g., the normalized overall RAF score for the patient might actually be lower than any individual output's raw contribution.

Linked Terms: CMS-HCC Missing Output Code and Description

CMS-HCC Model Outputs

Coded values generated by the CMS-HCC model representing distinct disease-component-related features of the patient that were used to calculate the RAF score. These may be individual HCCs (e.g., "HCC19", indicating the HCC for Diabetes without Complication in the v24 model) or other concepts (e.g., "HCC85_HCC96", representing the additional risk associated with the interaction of Congestive Heart Failure and Specified Heart Arrhythmias in the v24 model).

CMS-HCC Original Reason for Entitlement Code

The CMS Original Reason for Entitlement Code (OREC) for the patient used by the CMS-HCC model. Takes the same values as the standard CMS Original Reason for Entitlement Code field. This value is obtained from the MMR if available there, then from the membership record. Because the model requires this code as an input, patients are assumed to be OREC = Aged if their true status is not known.

Linked Terms: [URSA-CORE] CMS Original Reason for Entitlement Code

CMS-HCC Original Reason for Entitlement Code Description

The natural language description of the CMS-HCC Original Reason for Entitlement Code.

Linked Terms: CMS-HCC Original Reason for Entitlement Code

CMS-HCC Patient Age

For a given reference date or month, the patient age, expressed as an integer, evaluated as of February 1 of the calendar year containing the reference date or month; this is the method used to establish a patient's age for calculation of HCC/RAF score results.

CMS-HCC Patient Sex Code

Takes the value of "M" for male patients and "F" for female patients, which are the values expected by the CMS-HCC RAF score model. Because the model requires patient sex as an input, patients are assumed to be female if their sex is not known.

CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score generated using diagnoses and other input data as of the time period on the current record but using the model blend of 2024 (i.e., 67% from v24 and 33% from v28).

CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score generated using diagnoses and other input data as of the time period on the current record but using the model blend of 2025 (i.e., 33% from v24 and 67% from v28).

CMS RAF Type Code

The standard 1- or 2-character CMS Part C Risk Adjustment Factor Type Code; e.g., E = New Enrollee, I = Institutional, D = Dialysis (ESRD), CF = Community Full Dual, CP = Community Partial Dual, CN = Community Non-Dual, etc.

Count Historical-Diagnoses CMS-HCC v24 Outputs Missing from Within-Year-Updated Outputs

A count of all distinct outputs produced by the CMS-HCC v24 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is the count of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Count Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs

A count of all distinct outputs produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is the count of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Diagnosis Effective Date

The date of the diagnosis is considered to have been assigned to the patient for CMS-HCC model calculation purposes; may be different than the date the diagnosis record was submitted to CMS.

Final Run CMS MMR Part A RAF Score

The CMS MMR Part A RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Final Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their final run of RAF scores.

Linked Terms: [URSA-CORE] CMS MMR Part A RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Final Run CMS-HCC Scenario

Final Run CMS MMR Part B RAF Score

The CMS MMR Part B RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Final Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their final run of RAF scores.

Linked Terms: [URSA-CORE] CMS MMR Part B RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Final Run CMS-HCC Scenario

Final Run CMS MMR Part D RAF Score

The CMS MMR Part D RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Final Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their final run of RAF scores.

Linked Terms: [URSA-CORE] CMS MMR Part D RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Final Run CMS-HCC Scenario

Final Run CMS RAF Type Code

The CMS RAF Type Code value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Final Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their final run of RAF scores.

Linked Terms: CMS RAF Type Code, [URSA-CORE] CMS MMR Payment Date, Standard Final Run CMS-HCC Scenario

Historical-Diagnoses CMS-HCC Demographic Component RAF Score

The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC Disease Component RAF Score

The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC RAF Score

The normalized CMS-HCC RAF score calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score calculated using the 2024 blend under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC RAF Score Using 2024 Blend, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score calculated using the 2025 blend under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC RAF Score Using 2025 Blend, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC Raw RAF Score

The raw (non-normalized) CMS-HCC RAF score calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC Scenario

An approach to calculating a counterfactual CMS-HCC RAF score as of a given reference date in which every qualifying diagnosis from the prior 3 years are used, in addition to any diagnoses in the reference calendar year-to-date, to calculate the RAF score.

Historical-Diagnoses CMS-HCC v24 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v24 model run under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v24 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v24 model run under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v24 Outputs Missing from Within-Year-Updated Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v24 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is a list of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v24 Outputs Missing from Within-Year-Updated Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v24 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is the list of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v24 RAF Score

The normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, using the CMS-HCC model v24.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v28 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v28 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is a list of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is the list of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year.

Linked Terms: CMS-HCC Model Outputs, Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Historical-Diagnoses CMS-HCC v28 RAF Score

The normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, using the CMS-HCC model v28.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario

Historical-Diagnoses vs. Standard Final Action CMS-HCC RAF Score Gap

The difference between the CMS-HCC RAF score calculated under the Historical-Diagnoses scenario and the Standard Final Action scenario; represents a theoretical increase to RAF score if all qualifying historical diagnoses had been redocumented in the reference calendar year.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario, Standard Final Action CMS-HCC Scenario

Historical-Diagnoses vs. Within-Year-Updated CMS-HCC RAF Score Gap

The difference between the CMS-HCC RAF score calculated under the Historical-Diagnoses scenario and the Within-Year-Updated scenario; represents a theoretical increase to RAF score if all qualifying historical diagnoses had been redocumented in the reference calendar year.

Linked Terms: Historical-Diagnoses CMS-HCC Scenario, Within-Year-Updated CMS-HCC Scenario

Initial Run CMS MMR Part A RAF Score

The CMS MMR Part A RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Initial Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their initial run of RAF scores, even if more recent RAF scores from subsequent runs have since been provided.

Linked Terms: [URSA-CORE] CMS MMR Part A RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Initial Run CMS-HCC Scenario

Initial Run CMS MMR Part B RAF Score

The CMS MMR Part B RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Initial Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their initial run of RAF scores, even if more recent RAF scores from subsequent runs have since been provided.

Linked Terms: [URSA-CORE] CMS MMR Part B RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Initial Run CMS-HCC Scenario

Initial Run CMS MMR Part D RAF Score

The CMS MMR Part D RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Initial Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their initial run of RAF scores, even if more recent RAF scores from subsequent runs have since been provided.

Linked Terms: [URSA-CORE] CMS MMR Part D RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Initial Run CMS-HCC Scenario

Initial Run CMS RAF Type Code

The CMS RAF Type Code value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Initial Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their initial run of RAF scores, even if more recent RAF scores from subsequent runs have since been provided.

Linked Terms: CMS RAF Type Code, [URSA-CORE] CMS MMR Payment Date, Standard Initial Run CMS-HCC Scenario

Is CMS Dual Coverage Level Full

Indicates, for dually eligible patients, whether their coverage meets the CMS criteria for "Full Coverage". Among other potential uses, this value is used in the calculation of RAF scores.

Is CMS Dual Coverage Level Partial

Indicates, for dually eligible patients, whether their coverage meets the CMS criteria for "Partial Coverage". Among other potential uses, this value is used in the calculation of RAF scores.

Is CMS-HCC Medicaid Patient

The binary value used by the CMS-HCC model to identify Medicaid patients. Derived, when possible, from the CMS RAF Type Code (obtained either from an MMR record or a membership record).

Linked Terms: CMS RAF Type Code

Linked Value Sets: FULL DUAL STATUS (URSA-HCC CMS_RAF_TYPE_CODE), PARTIAL DUAL STATUS (URSA-HCC CMS_RAF_TYPE_CODE)

Is CMS MAO-004 Diagnosis

Indicates that at least one qualifying MAO-004 diagnosis code record was present for the given patient-date-diagnosis code triple. Useful for applying restrictions to use only certain types of diagnosis codes to generate HCC/RAF scores.

Is Institutional Bill Diagnosis

Indicates that at least one qualifying institutional bill diagnosis code record was present for the given patient-date-diagnosis code triple. Useful for applying restrictions to use only certain types of diagnosis codes to generate HCC/RAF scores.

Is Institutional Claim Diagnosis

Indicates that at least one qualifying institutional claim diagnosis code record was present for the given patient-date-diagnosis code triple. Useful for applying restrictions to use only certain types of diagnosis codes to generate HCC/RAF scores.

Is Medicaid Patient

Indicates the patient is a Medicaid plan member; operationalized as having at least one contemporaneous membership for a plan with Is Financial Class Medicaid = True.

Linked Terms: [URSA-CORE] Is Financial Class Medicaid

Is Medicare Advantage Patient

Indicates the patient is a Medicare Advantage plan member; operationalized as having at least one contemporaneous membership for a plan with Is Financial Class Medicare Advantage = True.

Linked Terms: [URSA-CORE] Is Financial Class Medicare Advantage

Is Medicare FFS Patient

Indicates the patient is a Medicare Fee-for-Service (FFS) beneficiary; operationalized as having at least one contemporaneous membership for a plan with Is Financial Class Medicare FFS = True.

Linked Terms: [URSA-CORE] Is Financial Class Medicare FFS

Is Model v24 Output

Indicates the record contains information on a model output produced by the CMS-HCC v24 model.

Linked Terms: CMS-HCC Model Outputs

Is Model v28 Output

Indicates the record contains information on a model output produced by the CMS-HCC v28 model.

Linked Terms: CMS-HCC Model Outputs

Is Patient With CMS-HCC Calculations Using Bill Diagnoses

Indicates the CMS-HCC model used at least one qualifying bill diagnosis record to calculate this patient's HCC/RAF score in at least one time period.

Is Patient With CMS-HCC Calculations Using Claim Diagnoses

Indicates the CMS-HCC model used at least one qualifying claim diagnosis record to calculate this patient's HCC/RAF score in at least one time period.

Is Patient With CMS-HCC Calculations Using MAO-004 Diagnoses

Indicates the CMS-HCC model used at least one MAO-004 diagnosis record to calculate this patient's HCC/RAF score in at least one time period.

Is Professional Bill Diagnosis

Indicates that at least one qualifying professional bill diagnosis code record was present for the given patient-date-diagnosis code triple. Useful for applying restrictions to use only certain types of diagnosis codes to generate HCC/RAF scores.

Is Professional Claim Diagnosis

Indicates that at least one qualifying professional claim diagnosis code record was present for the given patient-date-diagnosis code triple. Useful for applying restrictions to use only certain types of diagnosis codes to generate HCC/RAF scores.

Last CMS MAO-004 Encounter Submitted Date

The most recent date a MAO-004 encounter record was submitted to CMS for a given patient-date-diagnosis code triple.

Midyear Run CMS MMR Part A RAF Score

The CMS MMR Part A RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Midyear Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their midyear run of RAF scores, even if more recent RAF scores from subsequent runs have since been provided.

Linked Terms: [URSA-CORE] CMS MMR Part A RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Midyear Run CMS-HCC Scenario

Midyear Run CMS MMR Part B RAF Score

The CMS MMR Part B RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Midyear Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their midyear run of RAF scores, even if more recent RAF scores from subsequent runs have since been provided.

Linked Terms: [URSA-CORE] CMS MMR Part B RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Midyear Run CMS-HCC Scenario

Midyear Run CMS MMR Part D RAF Score

The CMS MMR Part D RAF Score value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Midyear Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their midyear run of RAF scores, even if more recent RAF scores from subsequent runs have since been provided.

Linked Terms: [URSA-CORE] CMS MMR Part D RAF Score, [URSA-CORE] CMS MMR Payment Date, Standard Midyear Run CMS-HCC Scenario

Midyear Run CMS RAF Type Code

The CMS RAF Type Code value on the MMR transaction record with the most recent CMS MMR Payment Date falling within the Standard Midyear Run CMS-HCC Scenario timeframe. Effectively, this value represents the results generated by CMS in their midyear run of RAF scores, even if more recent RAF scores from subsequent runs have since been provided.

Linked Terms: CMS RAF Type Code, [URSA-CORE] CMS MMR Payment Date, Standard Midyear Run CMS-HCC Scenario

Primary Diagnosis Document ID

The Document ID for the qualifying claim or billing diagnosis record, or qualifying MAO-004 diagnosis record, supplying the diagnosis code for the given patient-calendar date (potentially among multiple qualifying records).

Linked Terms: [URSA-CORE] Document ID

Standard Final Action CMS-HCC Demographic Component RAF Score

The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC Disease Component RAF Score

The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC RAF Score

The normalized CMS-HCC RAF score calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score calculated using the 2024 blend under the Standard Final Action scenario.

Linked Terms: CMS-HCC RAF Score Using 2024 Blend, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score calculated using the 2025 blend under the Standard Final Action scenario.

Linked Terms: CMS-HCC RAF Score Using 2025 Blend, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC Raw RAF Score

The raw (non-normalized) CMS-HCC RAF score calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC Scenario

An approach to calculating a CMS-HCC RAF score as of a given reference date that uses the patient's most recent ("final action") demographics for that reference date with all qualifying diagnoses (from both final action claims and final action MAO-004 encounters) in the prior calendar year, following the standard catchment period window.

Standard Final Action CMS-HCC v24 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v24 model run under the Standard Final Action scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC v24 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v24 model run under the Standard Final Action scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC v24 RAF Score

The normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, using the CMS-HCC model v24.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC v24 to v28 Increase in RAF Score

The increase in RAF score from the Standard Final Action CMS-HCC v24 RAF score to the CMS-HCC v28 RAF score; a positive number indicates the v28 score is higher than the v24 score.

Linked Terms: Standard Final Action CMS-HCC v24 RAF Score, Standard Final Action CMS-HCC v28 RAF Score

Standard Final Action CMS-HCC v28 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v28 model run under the Standard Final Action scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC v28 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Standard Final Action scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Final Action CMS-HCC Scenario

Standard Final Action CMS-HCC v28 RAF Score

The normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, using the CMS-HCC model v28.

Linked Terms: Standard Final Action CMS-HCC Scenario

Standard Final Run CMS-HCC Scenario

An approach to calculating a CMS-HCC RAF score that replicates the standard CMS deadlines and diagnosis catchment periods used to produce the "Final Run" CMS RAF score results. For example, Final Run RAF scores for 2023 incorporate diagnoses with dates of service between January 2022 and December 2022 and submitted by January 31, 2024.

Standard Initial Run CMS-HCC Demographic Component RAF Score

The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Initial Run scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC Disease Component RAF Score

The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Initial Run scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC RAF Score

The normalized CMS-HCC RAF score calculated under the Standard Initial Run scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score calculated using the 2024 blend under the Standard Initial Run scenario.

Linked Terms: Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score calculated using the 2025 blend under the Standard Initial Run scenario.

Linked Terms: Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC Raw RAF Score

The raw (non-normalized) CMS-HCC RAF score calculated under the Standard Initial Run scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC Scenario

An approach to calculating a CMS-HCC RAF score that replicates the standard CMS deadlines and diagnosis catchment periods used to produce the "Initial Run" CMS RAF score results. For example, Initial Run RAF scores for 2023 incorporate diagnoses with dates of service between July 2021 and June 2022 and submitted by September 2, 2022. Obtains the appropriate deadline for each year from the RAF SCORE INITIAL RUN DATA SUBMISSION DEADLINE DATE Lookup Table.

Standard Initial Run CMS-HCC v24 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v24 model run under the Standard Initial Run scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC v24 RAF Score

The normalized CMS-HCC RAF score, calculated under the Standard Initial Run scenario, using the CMS-HCC model v24.

Linked Terms: Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC v28 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Standard Initial Run scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Initial Run CMS-HCC Scenario

Standard Initial Run CMS-HCC v28 RAF Score

The normalized CMS-HCC RAF score, calculated under the Standard Initial Run scenario, using the CMS-HCC model v28.

Linked Terms: Standard Initial Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC Demographic Component RAF Score

The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Midyear Run scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC Disease Component RAF Score

The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Midyear Run scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC RAF Score

The normalized CMS-HCC RAF score calculated under the Standard Midyear Run scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score calculated using the 2024 blend under the Standard Midyear Run scenario.

Linked Terms: Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score calculated using the 2025 blend under the Standard Midyear Run scenario.

Linked Terms: Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC Raw RAF Score

The raw (non-normalized) CMS-HCC RAF score calculated under the Standard Midyear Run scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC Scenario

An approach to calculating a CMS-HCC RAF score that replicates the standard CMS deadlines and diagnosis catchment periods used to produce the "Initial Run" CMS RAF score results. For example, Midyear Run RAF scores for 2023 incorporate diagnoses with dates of service between January 2022 and December 2022 and submitted by March 4, 2023. Obtains the appropriate deadline for each year from the RAF SCORE MIDYEAR RUN DATA SUBMISSION DEADLINE DATE Lookup Table.

Standard Midyear Run CMS-HCC v24 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v24 model run under the Standard Midyear Run scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC v24 RAF Score

The normalized CMS-HCC RAF score, calculated under the Standard Midyear Run scenario, using the CMS-HCC model v24.

Linked Terms: Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC v28 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Standard Midyear Run scenario.

Linked Terms: CMS-HCC Model Outputs, Standard Midyear Run CMS-HCC Scenario

Standard Midyear Run CMS-HCC v28 RAF Score

The normalized CMS-HCC RAF score, calculated under the Standard Midyear Run scenario, using the CMS-HCC model v28.

Linked Terms: Standard Midyear Run CMS-HCC Scenario

Within-Year-Updated CMS-HCC Demographic Component RAF Score

The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC Disease Component RAF Score

The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC RAF Score

The normalized CMS-HCC RAF score calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC RAF Score Using 2024 Blend

The CMS-HCC RAF score calculated using the 2024 blend under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC RAF Score Using 2024 Blend, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC RAF Score Using 2025 Blend

The CMS-HCC RAF score calculated using the 2025 blend under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC RAF Score Using 2025 Blend, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC Raw RAF Score

The raw (non-normalized) CMS-HCC RAF score calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC Scenario

An approach to calculating a CMS-HCC RAF score as of a given reference date in which only qualifying diagnoses documented since the start of the calendar year containing the reference date are used in the RAF score calculation (i.e., diagnoses documented later in the year, after the reference date, are ignored).

Within-Year-Updated CMS-HCC v24 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v24 model run under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC Model Outputs, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC v24 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v24 model run under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC Model Outputs, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC v24 RAF Score

The normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, using the CMS-HCC model v24.

Linked Terms: Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC v28 All Outputs Description

A summary description, in the form of a semicolon-delimited text string, of all outputs produced by the CMS-HCC v28 model run under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC Model Outputs, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC v28 All Outputs Summary

A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Within-Year-Updated scenario.

Linked Terms: CMS-HCC Model Outputs, Within-Year-Updated CMS-HCC Scenario

Within-Year-Updated CMS-HCC v28 RAF Score

The normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, using the CMS-HCC model v28.

Linked Terms: Within-Year-Updated CMS-HCC Scenario