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

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: Will issuers need to research overlapping claims in the small group market, or only overlapping claims in the individual market?

Answer: The Centers for Medicare & Medicaid Services (CMS) recommends, but does not require issuers to research the claims that are overlapping to determine the actual effect on the Reinsurance (RI) and Risk Adjustment (RA) calculations. At this time, CMS expects claims discovered in the small group market to be of negligible impact.

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