Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: Will the Centers for Medicare & Medicaid Services (CMS) disclose the amount of Reinsurance (RI) being withheld during the attestation or research processes?

Answer: CMS will determine initial adjustment amounts based on the summary results returned by the Overlapping Claims Summary Count query. CMS is currently setting the deadline for issuers to provide detailed information on overlapping claims, which may result in readjusted RI payments based on issuer research.

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