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

Cost and Quality Thresholds

• 2024 Episodes of Care Thresholds
• 2023 Episodes of Care Thresholds
• 2022 Episodes of Care Thresholds
• 2021 Episodes of Care Thresholds
• 2020 Episodes of Care Thresholds
• 2019 Episodes of Care Thresholds
• 2018 Episodes of Care 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:

Contact us at payment.reform@tn.gov