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: The EDGE Server Business Rules (ESBR) v2.0 document states 'only pharmacy claims for enrollees in the individual and small group market, both inside and outside the Marketplace will be accepted.' Since pharmacy claims are only used for the Reinsurance (RI) program, which only applies to individual plans, are issuers required to submit pharmacy claims for small group health plans to the EDGE server?

Answer: Regardless of market type (individual or small group) issuers must submit all data types (enrollment, pharmacy, medical and supplemental diagnosis) to the EDGE server.

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