The Background section of this guide could use more information providing context around communications between providers and payers. It is our understanding that typically payers drive the risk adjustment process by requesting relevant information from practices, as suggested in Figure 1-2. By contrast, Figure 1-3 and the verbiage of the IG suggest that providers primarily take the initiative to request coding gap information (as they would in a VBP arrangement). This may be unrealistic. We recommend adding more clarifying context, and/or incorporating a workflow into the guide that reflects the payers role in requesting information for risk adjustment.