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

Issue Date: May 25, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: When reporting a discovered Hierarchical Condition Category (HCC) discrepancy, should issuers submit all eXtensible Markup Language (XML) files associated with that member, or only the selection related to the discrepant HCC?

Answer: Issuers should submit only a claim-specific snippet of the XML records associated with a member for the discrepancy reporting process. The Centers for Medicare & Medicaid Services (CMS) also request that issuers avoid submitting Personally Identifiable Information (PII) as part of discrepancy reporting.

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