Medicare AdvantageDocumentationMedium impact
Risk Adjustment: Importance of HCC Gap Closures
Highmark·Provider Bulletin
We identified it
May 11, 2026
Summary
Highmark emphasizes the importance of documenting and reporting all chronic conditions annually for Medicare Advantage patients, particularly early in the year, to ensure proper HCC gap closure and risk adjustment. Providers should schedule annual wellness visits early and document all chronic conditions during the first patient visit of the year to support accurate disease burden capture.
Action Required
Immediately: Scheduling staff should prioritize annual wellness visits early in the calendar year for all Medicare Advantage patients. Providers must document and submit claims for ALL chronic conditions during each patient's first visit of the year, even when treating acute problems. Clinical staff should implement pre-visit evaluation processes to assist with chronic condition documentation and schedule any necessary follow-up appointments as early in the year as possible.