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

Issue Date: March 28, 2016

Program Area: Reinsurance (RP)

Question: When will the Centers for Medicare & Medicaid Services (CMS) notify issuers who are considered data outliers?

Answer: In January and February of 2016, CMS performed two rounds of data outlier analysis and notified issuers whether they were deemed outliers by sending letters to their External Data Gathering Environment (EDGE) CEO-designates and alternates. Issuers should continue to update their 2015 Benefit Year EDGE data. CMS will continue to assess data and notify issuers that are outliers as indicated in the 'Evaluation of EDGE Data Submissions for 2015 Benefit Year' posted March 18, 2016 on the CMS website https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Part-2-EDGE-Q_Q-Guidance_03182016.pdf.

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