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

Issue Date: September 27, 2018

Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server

Question: Can you further define the requirements for the baseline cross-year (CY) claims request, specifically pharmacy?

Answer: In the Benefit Year 2018 Baseline Submission web form, CMS added three (3) new fields requesting CY claims information be provided separately from other claims information. This is in contrast to previous years where CY claims information was requested to be submitted as part of the Quarter 1 baseline data. The new fields are the (1) total CY medical claims count, (2) total CY Rx claims count, and (3) total CY claims paid amount. For all three (3) fields, cross year claim is defined as a claim with a date of service beginning in 2017 and an end date in 2018. For total CY Rx claims count, CMS is requesting that issuers provide the total number of HCPCs for pharmacy that are in the CY medical claims count and being submitted for an issuer's BY2018 EDGE server data. The Healthcare Common Procedure Coding System (HCPCS) may or may not map to an RXC. Please copy and paste the following web link into your browser to access the EDGE Issuer Clarifications and Announcements (https://www.regtap.info/reg_librarye.php?i=2663) for additional information on pharmacy counts and paid amounts.

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