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

Issue Date: July 08, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: Does the Centers for Medicare & Medicaid Services (CMS) recommend that issuers submit requests for reconsideration only if the discrepancy reporting process for a given issue is concluded?

Answer: Not necessarily. Issuers who wish to appeal resolved discrepancies should submit a request for reconsideration to do so; however, issuers with outstanding discrepancies at the August 1, 2016 deadline should also submit a request for reconsideration while awaiting the discrepancy's resolution. CMS does not have a timeline for when all discrepancies are to be resolved; however, the deadline to file a request for reconsideration is August 1, 2016. If an issuer files an appeal and the discrepancy is resolved, the issuer can withdraw the request for reconsideration; however, CMS will not accept any additional requests for reconsideration after the August 1, 2016 deadline.

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