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

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: Can the Centers for Medicare & Medicaid Services (CMS) confirm that all issuers must run the Overlapping Claims Summary Count query and report all results returned by the query, even valid claims that do not impact Reinsurance (RI) payments?

Answer: Yes. All issuers must run the Overlapping Claims Summary Count query and report any claims discovered by the query as a discrepancy. CMS will send an Overlapping Claims Web Form to issuers who have reported overlapping claims discrepancies on June 1, 2016. Issuers will use the form to indicate whether any of the claims identified by the Overlapping Claims Summary Count query should be considered valid or do not otherwise affect RI.

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