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Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server FAQ

Guidance for FAQ regarding Edge Server Operations and Reports

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

Question: How will the Centers for Medicare & Medicaid Services (CMS) report orphaned supplemental diagnosis records to issuers, and when will CMS provide report specifications?

Answer: Issuers will receive an EDGE Server Enrollee (With and Without) Claim Detail report (orphaned claims) on enrollee IDs that do not have any associated claims as well as any claim IDs that have no associated enrollment record for the enrollee ID on the claim. At this time there is no separate report planned for supplemental claims that do not have an enrollment record for the enrolled ID. However, since supplemental diagnosis files (ESSFS) must provide a linked, active medical claim ID, if a claim ID from a supplemental diagnosis file appears on the EDGE Server Enrollee (With and Without) Claim Detail report, then by association the supplemental diagnosis record will also be orphaned. For additional information, please review the EDGE Server Business Rules (ESBR), located under the Distributed Data Collection (DDC) program area at https://www.REGTAP.info in the REGTAP Library.

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

Issue Date: November 25, 2014

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