Upcoming CMS Deadline: Final Notice for 2026 Risk Adjustment Data Submission
It’s time again for Medicare Advantage, PACE, Duals, and CMS experimental plans to submit risk adjustment data. This data is used for risk scoring and may impact additional payments in upcoming years.
Submit Your Risk Adjustment Data Now
Risk adjustment data, including that in RAPS (Risk Adjustment Processing System) and EDS (Encounter Data System), must be submitted to CMS by 8:00 PM EST on February 2, 2026. Any data submitted after this time and date will not be included in the respective model run, with no exceptions allowed.
Risk adjustment data submitted after the initial deadline but before the mid-year deadline will be incorporated into the mid-year run. Similarly, any data provided after the mid-year deadline but prior to the final reconciliation deadline will be included in the final reconciliation run.
CMS strongly encourages Payers to submit data in advance of the deadline to ensure ample time to resolve submission issues. These issues including validation errors, data rejections, or inaccuracies. Early submission also ensures appropriate revenue based on member risk profiles.
Financial Consequences of Missing the Deadline
Meeting the February deadline is crucial for the calculation of risk scores for payment years 2025, 2026, and 2027. If data is submitted after the deadline, it will not be reflected in the respective model run. CMS will not make additional payments for diagnoses received after this deadline.
Maximize Financial Performance with FRG’s Revenue Audit and Monitoring Program (RAMP)
RAMP highlights opportunities for payers and providers to restore historically documented chronic condition codes and capture missing diagnosis codes. This ensures revenue alignment to the cost of care.
RAMP searches for missing diagnoses and matches codes by analyzing CMS data, claims, and other records to accurately identify diagnoses that providers haven’t documented. Utilization data, measures-related care, and pharmacy records often reveal health issues that need coding. These insights help payers properly adjust risk scores, so care management can be optimized for improved health outcomes.
Get Started with RAMP
FRG RAMP analyzes member-level data for each payment year to create accurate forecasts for revenue recapture. Its clear findings help payers plan member outreach, support providers, and fix coding errors, so members receive the care they need.
To learn more about FRG and how RAMP can set your organization on a path to achieving accurate risk adjustment and financial health, Contact Us online or call 888-466-1025 to schedule a demo.