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Simplifying the complexity of health care

Cirdan Health Systems and Consulting can help guide you through the twists and turns of today's health care issues. Our actuaries and consultants are experienced in finance, strategic planning, HMO operations, public policy, pay-for-performance, risk adjustment, and new product development. We can provide you with senior level insight as well as the flexibility and personal attention you need to ensure your efforts are effective.

Our data-warehousing services and IT professionals can provide a cost-effective means to obtain the information necessary to manage contracts, identify cost drivers, manage Medicaid and dual-eligible populations, support Medicare Advantage bids (Parts C and D), and evaluate P4P programs.

RAPS to EDPS Transition Report



MAO-004 Version 3 to be released soon.

MAO plans have long been concerned about problems with the MAO-004 Version 2 report. On March 23, 2017, CMS shared new details about the Version 3 MAO-004 Report.

The changes CMS made for Version 3 relative to Version 2 are significant for "processing" the MAO-004 data. Key changes in logic include:

  • Assignment of Allowed/Disallowed status for the encounter and any linked encounter
  • Refined definition for "blank" diagnosis indicators
  • New reporting for replacements to original encounters regardless of whether diagnoses are unchanged from the original submission
  • Allowed/Disallowed Reason Codes to help understand why diagnoses are disallowed or if a change has occurred from disallowed to allowed
  • Expansion of number of clusters to 38 per line in report

Version 3 Reports are expected to be released by April 7th, 2017. Cirdan will immediately evaluate the impact of the change on its clients and share our observations.