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: Some issuers may have three (3) separate vendors that provide pharmacy, vision and dental care data to submit for EDGE server reporting. When loading monthly or quarterly data to the EDGE server, should the EDGE report reflect one (1) file for each line of business or one (1) file that encompasses all lines of business?

Answer: Pharmacy data submissions should be uploaded to the EDGE server on the EDGE Server Pharmacy Claim Submission (ESPCS) file. All dental and vision claims covered under major medical should be included on the ESMCS file. However, stand-alone dental plans and stand-alone vision plans are excluded from Risk Adjustment (RA) and Reinsurance (RI) and should not be submitted to the EDGE server for consideration. Please note that each EDGE server submission file should only contain information for one issuer. Information on the requirements for each of type of file submission can be found in the EDGE Server Business Rules (ESBR) and the Interface Control Document (ICD) posted in the REGTAP Library.

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