HCC Risk Adjustment Data Model: Building Accurate Risk Score Pipelines in SQL

For a Medicare Advantage plan with 100,000 members, a 0.01 difference in average RAF score translates to roughly $4 million in annual revenue . A modeling error that drops 3% of valid diagnosis codes does not produce an error. The pipeline runs clean, the submission goes out, and the plan receives significantly less than it should. You find out twelve months later during reconciliation — if at all. This guide covers the CMS-HCC data model, the pipeline architecture that produces accurate RAF sco