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

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: Does the Centers for Medicare & Medicaid Services (CMS) require issuers with overlapping claims to indicate that the information in the Reinsurance Detail Enrollee Report (RIDE) Report is incorrect when completing the Attestation and Discrepancy Reporting Form?

Answer: No. For overlapping claims discrepancies, issuers should only select 'Yes' to questions concerning the June 30, 2016 final Risk Adjustment (RA)/ Reinsurance (RI) reports. Issuers should indicate whether the issuer's Risk Adjustment Transfer Elements Extract (RATEE), Reinsurance Summary Report (RISR) or both are affected by discovered overlapping claims.

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