The federal government reimburses Medicare Advantage plans based on the documented health of their members through a method used by CMS called "Risk Adjustment." This reimbursement is based on the anticipated cost of members' healthcare and is what health plans rely on to accurately estimate healthcare costs and provide high-quality affordable Medicare Advantage products.

Providers play an important role in the risk adjustment process. Medical record documentation and claims coding data are used to help indicate the complete picture of health for plan members. This data also enables Blue Advantage to analyze and design programs to help manage member care.

Documentation and coding must mirror one another in order to accurately capture the patient's complete picture of health. Use our resources below to provide the most accurate, complete coding and documentation possible. 

Please note: If you are not a registered ProviderAccess user, some of the content will not be viewable. Contact the practice administrator for your associated practice for a user ID and password.  

For coding questions, contact our Coding Consultant by completing our online feedback form.

Documentation and Coding Tips

• Annual Wellness Visit Tips and Best Practices
• Common HCC ICD-10 Codes
• Documentation and Coding Guidance
• ICD-10 Data 
• Documentation and Coding by Condition:
  • Atherosclerosis
  • Cancer

  • Cerebral Infarction, Transient Ischemic Attack and Sequela
  • Chronic Lower Respiratory Diseases

  • Congestive Heart Failure

  • Deep Vein Thrombosis (DVT)
  • Depression

  • Diabetes Mellitus - Type 1
  • Diabetes Mellitus - Type 2 

  • Hypertensive Chronic Kidney Disease
  • Hypertensive Heart Disease
  • Hypertensive Heart and Chronic Kidney Disease
  • Morbid Obesity
  • Rheumatoid Arthritis

  • Risk Overview

• Strategies for Improving Medication Adherence