For the 2023 benefit year, the absolute value of all transfers totaled nearly $20.6 billion, meaning $10.3 billion was charged to plans with lower risk scores and $10.3 billion in payments was received by plans with higher risk scores.
As Marketplace plans optimize their risk adjustment programs to ensure successful execution in 2026, read Cotiviti’s new white paper as we highlight strategies to address changes introduced by the HHS Notice of Benefit and Payment Parameters for 2026, including:
- Coverage design
- Risk Adjustment Data Validation (RADV) audit methodology
- HHS risk adjustment user fee and medical loss ratio (MLR) regulations
Dive in as we explore strategies and actions that will set up Qualified Health Plans (QHPs) for success in each of these areas, with a focus on deploying analytics, provider education, member engagement, and audit strategies.
With preparation, QHPs can better position themselves to improve risk score accuracy, optimize their programs, and help ensure financial stability as 2026 approaches. Don’t miss this opportunity to strengthen your risk adjustment program and better prepare for future audits.
