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

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: If an issuer's research shows that all overlapping claims discovered by the Overlapping Claims Summary Count query were correctly identified as discrepancies, and the initial reduction to that issuer's Reinsurance (RI) payments was correct, must the issuer still submit detailed claim research information on the July 1, 2016 Overlapping Claims Web Form?

Answer: The Centers for Medicare & Medicaid Services (CMS) will provide guidelines on detailed reporting of issuer research and completion of the Overlapping Claims Web Form at a later date.

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