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

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: When submitting a discrepancy report for overlapping claims, how should issuers respond to the following questions: 'Is this discrepancy related to any of your External Data Gathering Environment (EDGE) reports?' and 'Is this discrepancy related to any of your Risk Adjustment (RA)/Reinsurance (RI) reports'?

Answer: For overlapping claims discrepancies, issuers should select 'Yes' only to questions concerning the June 30, 2016 final Risk Adjustment (RA)/ Reinsurance (RI) reports and indicate whether the issuer's Risk Adjustment Transfer Elements Extract (RATEE), Reinsurance Summary Report (RISR) or both reports are affected.

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