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

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: When indicating the percent of the issuer's total claims that are affected by the overlapping claims discrepancy, should an issuer indicate individual and small group percentages on separate lines?

Answer: No. The issuer should indicate each Health Insurance Oversight System (HIOS) ID on a single row, and provide a single percentage for that row. The issuer should also check the indicator that the percentage provided applies to both the individual and small group markets under that HIOS ID if applicable.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.