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

Issue Date: February 05, 2020

Program Area: Payment Policy and Financial Management Group External Audits (PPFMG EA)

Question: Should the data reported in the desk audit file reflect what is in the issuers' systems today (i.e., reflect current information) or should it reflect data as of the date of the final, restated Enrollment and Payment Data Workbook (EPDW) (e.g., November 2016)?

Answer: The enrollment and payment data reported in the desk audit file should be a current snapshot of what is in the issuer's systems today (i.e., the current, most accurate effectuated enrollment and payment data, inclusive of any changes such as Health Insurance Caseworker System (HICS) case IDs, retroactive adjustments, etc.).

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