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

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: If an issuer has validated the Risk Adjustment Data Validation Population Statistics Summary (RADVPS) Report, run the Overlapping Claims Summary Count query and reported the results, will that be sufficient for the issuer to conclude that the issuer has no other discrepancies to report?

Answer: The Centers for Medicare & Medicaid Services (CMS) will require some specific validations from issuers; however, it is at the discretion of the issuer to determine whether additional data research is necessary to identify other discrepancies.

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.