Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server FAQ
Guidance for FAQ regarding Edge Server Operations and Data Submission - Other
Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server
Question: What eligibility dates and claim dates of service should an issuer submit beginning on January 1, 2014?
Answer: Data submitted to the Edge Server will only include small group and individual market plans that are eligible under the new market rules as of January 1, 2014. Therefore, only enrollment and claims information for these plans effective January 1, 2014 or later would be submitted. Edge Server enrollment submission files are full replacements; therefore, each enrollment submission should include all enrollment for the applicable enrollment periods. Pharmacy and medical claims submissions are not full replacement files; therefore, an individual claims file submission is not required to contain all claims data for the relevant dates of service. It is up to each issuer to determine the method by which they will produce and submit their claims data. Issuers should consider the impact of adjusted and voided claims when developing their processes.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 23, 2013
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
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.