CMS Raps File Format
Sep 19, 2014 … 120.3.1 – RAPS Reports … CMS risk adjusts Part D payments to Medicare
Advantage Prescription ….. information about the MMR file layout).
Risk Adjustment Data Submission Requirements – Plan Sponsors (Medicare.
Advantage ….. Table 20 describes each field of the current RAPS file layout.
RAPs are submitted on the Form CMS-1450 (UB-92) billing form under TOB (
Form …. submitted using the same formats as Medicare claims. ….. on file. FL 53.
Not required for Medicare HH RAP billing. FL 54. Not required for Medicare HH
claims be submitted to Medicare electronically, with some exceptions effective …
claim format will now be considered eligible for payment as early as the 14th day
after the ….. payment and payment for RAPs are not subject to payment floor
standards. … the UB-92 flat file, the National Standard Format (NSF), a pre-
30.7 – Closing, Adjusting and Prioritizing HH PPS Episodes Based on RAPs and
… 30.10 – Medicare Secondary Payment (MSP) and the HH PPS Episodes File …
MACs on a professional claim format (the 837professional or paper Form …
The outpatient provider (OPROV) specific file contains the required … FIs must
also furnish CMS a quarterly file in the same format. ….. on HH PPS RAPs.
The tables of RAPS File Layout with format changes are attached: … Version 12
CMS-HCC PTC MOR format, will expand to support a new record length of 200.
Jun 20, 2014 … 10/70.3/Decision Logic Used by the Pricer on RAPs. R …. claim format (the 837P
or paper Form CMS-1500). … Common Working File (CWF) indicates an episode
of care is open for a beneficiary, the Medicare contractor.
MSNs are not used by A/B MACs (HHH) for RAPs, and. RAP data are …. GLOBAL
NOTICE: This file version does not include specifications for Part A claims for
inpatient … MSNs also require a claim format more similar to Part B claims. • Part
Oct 30, 2015 … Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing
… format of ICD-10 codes. …. Anticipated Payment (RAPs)*.
Aug 28, 2015 … Medicare Advantage (MA) Capitation Rates, Part C and Part D …… data from
2012 fee-for-service (FFS) claims and MA-PD RAPS files, along …
Nov 30, 2016 … File.” Pg. 5. V36.0. 5/29/2015. Updates to PCUG Record Layout page ….
Beneficiaries. RAPS. Data. File. Daily. Gentran Mailbox/TIBCO MFT.
Effects. R. 10/30.5/National Home Health Prospective Payment Episode History
File. R …. Note that HHAs may not submit RAPs opening episodes when
anticipating a transfer ….. submitted using the same formats as Medicare claims.
Contractors must include a copy of the policy underlying denial in the case file. …
A. Example Format of An Overpayment Worksheet (also see Exhibit 46) …..
Indicate the volume (dollar and number of claims) of RAPs for the past 12 months
Oct 16, 2015 … ensure this, RAPs for all episodes with “from” dates before the termination ….. The
format of the treatment authorization code is shown here: ….. the hospice shall file
a timely-filed Notice of Election Termination / Revocation …
instructions for requests for anticipated payment (RAPs) and claims to conform ….
submitted using the same formats as Medicare claims. ….. on file. FL 53. Not
required for Medicare HH RAP billing. FL 54. Not required for Medicare HH RAP
The HH PC Pricer calculates payments for both RAPs and claims, requiring the
key entry of only the limited …. If your provider number is not this file, your RAP/
claim will be calculated with zero … Valid entries: Must use MM/DD/YY date
… data for each beneficiary across all claim files. …. certified by Medicare to
provide services to the beneficiary. ….. Z = Zero reimbursement RAPs — zero
reimbursement made due to …. NOTE: For HHA and Hospice formats beginning
with NCH …
For the electronic format (the UB-92 Flat File), the new requirements are
described …. RAPs. 3. Interim-Continuing Claims. (Not valid for PPS Bills). Use
this code …
Aug 17, 2015 … formats: comprehensive data equivalent to Medicare fee-for-service data … o
RAS will extract the enrollee diagnosis data files from RAPS and …