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

Issue Date: July 13, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: If an issuer discovers a discrepancy between the issuer's calculated Risk Adjustment (RA) payment amount and the amount calculated by the Centers for Medicare & Medicaid Services (CMS) greater than the materiality threshold, can the issuer file a request for reconsideration even if the issuer did not report a discrepancy during the formal discrepancy reporting period?

Answer: If an issue was identifiable during the formal attestation and discrepancy reporting period, issuers must have filed a discrepancy to later request reconsideration on the same issue. However, if the issue was not identifiable at the time of the attestation and discrepancy reporting period you may request reconsideration.

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.