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Enrollment and Eligibility (ENR) FAQ

Guidance for FAQ regarding Reconciliation and Reporting

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

Issue Date: April 04, 2016

Program Area: Enrollment and Eligibility (ENR)

Question: If an issuer receives a member's request to change/update the member's address, can the issuer change the address in the issuer's system after the issuer directs the member to the Federally-facilitated Marketplace (FFM) to make the update?

Answer: Issuer should direct members to report address changes/updates, particularly residential address; to the Federally-facilitated Marketplace (FFM). The issuer will receive the updated address in an 834 transaction, Pre-audit File, or in the Incremental Pre-Audit (IPA) file. Issuers should wait until they receive the member's updated address information from the FFM before updating their systems.

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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.