Technical Documents

The documents on this page contain technical information about each episode type:

  • The Detailed Business Requirement (DBR) document serves as a guide to understand the definition of an episode. DBRs are no longer hosted on this website and are now maintained by each Managed Care Organization (MCO). Please refer to the appropriate MCO’s Episode of Care website (see below) to access the most current DBR for an episode.
  • The Configuration File contains the parameters and medical codes needed to define the episode. You can request each episode’s Configuration File by emailing payment.reform@tn.gov.
  • The episode Summary provides an overview of the episode design for quick reference. Episode summaries can be found in the Episodes by Wave webpage.
  • The Episodes of Care Cost and Quality Thresholds document provides an overview of the thresholding process and annual values used to calculate gain-sharing or risk-sharing payments for accountable providers.

Episodes by Wave

48 Episodes by Wave

Cost and Quality Thresholds

Managed Care Organizations (MCOs) are responsible for the risk adjustment of episode costs. An episode’s risk-adjusted cost is the episode cost divided by a risk weight for the specific episode. The risk weight adjusts the cost of that episode. Each risk factor has an individual risk weight that is published on each MCO’s website:

Contact us at payment.reform@tn.gov