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: How do I split the claim lines when breaking up an outpatient cross-year (CY) claim?

Answer: Issuers may either (1) submit a final, aggregated claim or (2) submit a claim for each benefit year for CY outpatient claims. The EDGE Server Business Rule (ESBR) Section 7.18.3 provides details of how to submit CY outpatient claims including examples of how to apply the statement coverage dates and claim-line paid claim amounts when splitting the CY outpatient claims.

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