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

Issue Date: November 26, 2014

Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server

Question: In reference to the membership file, if a member was active and subsequently had a claim that has been paid, however the member was retroactively cancelled back to the initial effective date, should this member be included on the enrollee file?

Answer: If an issuer has submitted the enrollee once, each subsequent enrollment file submission should also include the enrollee. If an enrollee is retroactively terminated the issuer must update the 'Coverage End Date' of the enrollee. The only claims that will be considered for risk adjustment and reinsurance are those claims that are associated with an active enrollment period.

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