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Viewing:  Apr 26, 2017

HCC Risk Calculator

Model:    Code Set:

Subscribers can use the HCC Calculator to find risk scores based on diagnoses and demographic factors here.

Access to this feature is available in the following products:
  • Find-A-Code Professional
  • Find-A-Code Hospital/Facility

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Demo
Video

Instructions: Enter ICD diagnoses in the boxes below, and then demographic information for the enrollee.
Click the "Add" links for additional diagnosis boxes. When done, click the "Calculate" button. The resultant HCC Risk Score will display below the form.

Enrollee Details
ICD Code Description (will appear for codes) HCC
Diagnoses:
+ Add More...
Gender:
Age: (0-124)
Dual Eligible Status:
OREC: Original Reason for Medicare Entitlement
New Enrollee:  If the person is a New Enrollee in Medicare
Medicaid: If the number of months in Medicaid in base year > 0 (or payment year for new enrollees)
Institutional: If the person is cared for in an institutional setting.
Special Needs Plan: If the person is an enrollee in a Chronic Disease Special Needs Plans (SNP).
Kidney Status: If the person is currently on dialysis, or has a functioning graft (transplant)
Low Income: If the person is considered low-income.
ESRD: if person is in any of the following statuses: ESRD dialysis, transplant, post graft.
      
Calculator Results
Calculator results will display here
HCC risk factors and scores are presented only as supplemental guidance for issuers to better understand and simulate the calculation of plan liability risk scores for their enrollees and should not be relied upon for exact risk calculation. The actual software used to process claims may have additional layers of rules.




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