White Paper Outlines Best Practices for Medicaid MCO Risk Adjustment Operations

Milliman's second installment in a risk adjustment series argues that effective risk adjustment depends on coordinated organizational infrastructure—not just coding accuracy—spanning governance, staffing, provider engagement, data systems, and compliance functions. The paper provides operational benchmarks and leading practices applicable across Medicare Advantage, Medicaid, and ACA plans, with direct implications for how Medicaid managed care organizations structure teams, oversee vendors, and integrate risk adjustment into care management and revenue integrity workflows.

Managed Care · Finance

This is outside commentary from Milliman, not part of Medicaid Monitor's independently scored news coverage.

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