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: Can the Centers for Medicare & Medicaid Services (CMS) please confirm if a voided pharmacy claim amount should be included in the 'Total Plan Paid Amount' fields on the EDGE Server Pharmacy Claim Submission (ESPCS) file?

Answer: Pharmacy claims use eight (8) key data elements to identify a unique claim for purposes of identifying duplicates and processing void and replacement requests. When voiding a claim, only the eight (8) key elements need to be present. Therefore, no Total Plan Paid Amount is necessary when voiding a pharmacy claim. When replacing a claim, all data elements must be present.

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