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

Issue Date: November 14, 2014

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

Question: If a claim is orphaned, may an issuer submit the enrollee and enrollment period so the claim(s) may be considered for Risk Adjustment (RA) and/or Reinsurance (RI)?

Answer: Issuers will have an opportunity to review the Enrollee (Without) Claims Detail (ECD) Report, which includes Claim IDs that have no associated enrollment record for the Enrollee ID on the claim. An enrollment period may not be associated either because it was not submitted, the coverage period does not cover the claim date or service, or the Plan ID on the claim and enrollment period do not match. Issuers may make corrections by submitting new enrollee and/or enrollment periods so that orphaned claims may be considered in RA and RI. For more information, please see the Interface Control Document Addendum, located under the Distributed Data Collection (DDC) program area at https://www.REGTAP.info in the Registration for Technical Assistance Portal (REGTAP) Library.

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