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Vendor Management, Payments, and Collections (VMPC) FAQ

Guidance for FAQ regarding Payment Processing and Payment Reports

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

Issue Date: May 18, 2016

Program Area: Vendor Management, Payments, and Collections (VMPC)

Question: Will the Centers for Medicare & Medicaid Services (CMS) accept an Issuer's Payment Dispute Form if the Exchange Assigned Policy IDs do not match the Exchange Assigned Policy IDs reported in the Preliminary Payment Report (PPR)?

Answer: Yes, however, the Exchange Assigned Policy ID (F4) is used as part of the automated processing logic. If the Exchange Assigned Policy ID reported on the dispute form is not found on the PPR cited in the header record (as reported by the issuer in H7, PPR Transaction Set Control Number), then the dispute will be processed and is likely to receive a reject disposition.

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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.