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 benefit year start date (field 10) and benefit year end date (field 11) reported in the desk audit file be the same for each 01 record or should the dates reflect the month of coverage associated with each 01 record?

Answer: The benefit year start and end dates reported for each 01 record reported in the desk audit file should reflect the entire period of coverage associated with the subscriber's enrollment in the qualified health plan (QHP). The dates should be the same for each 01 record associated with the enrollment. For example, if a subscriber's enrollment in the QHP is effective from 01/01/2015 through 09/30/2015, there should be nine 01 records and each 01 record should have a benefit year begin date of 20150101 and a benefit year end date of 20150930.

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