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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. You can find each episode’s DBR in the Searchable Episodes Table.
  • The Configuration File contains the parameters and medical codes needed to define the episode. You can find each episode’s Configuration File in the Searchable Episodes Table.
  • The episode Summary provides an overview of the episode design for quick reference. Episode summaries are included in both the Searchable Episodes Table and Episodes by Wave.
  • 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.

Searchable Episodes Table

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:

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