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) require issuers to provide detailed research on only claims identified by the Overlapping Claims Summary Count query, or on all of the issuer's External Data Gathering Environment (EDGE) server data?

Answer: Issuers should only research overlapping claims identified by the query. CMS is developing a new query to identify overlapping claims for only enrollees who are elligible for Reinsurance (RI).

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