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

Issue Date: July 18, 2016

Program Area: ACA Financial Appeals (ACA FA)

Question: An issuer did not submit a member's 10 claims for the Cost-sharing Reduction (CSR) Reconciliation appeals process because the issuer identified an error within the first claim. Will the Centers for Medicare & Medicaid Services (CMS) allow the issuer to submit the claims for the member?

Answer: CMS does not allow issuers to use the discrepancy process to submit 2015 re-adjudicated claims. If an issuer discovers an error within a CSR claim, the issuer may submit the claim for the appeals process.

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