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: Issuers have about three (3) percent of policies billed off cycle, so instead of billing for the calendar month, issuers bill from the 15th to the 14th. Do issuers have to convert those to calendar months in order to report them to the Department of Health and Human Services (HHS)?

Answer: The EDGE Server Business Rules (ESBR) state that when a subscriber has either a partial month or $0 Premium Amount, issuers must create a distinct enrollment period, an enrollment period for a full month premium rate and an enrollment period for a partial month or $0 Premium Amount. In the scenario where an issuer bills premiums from the 15th to the 14th of the month, the issuer will need to create three (3) enrollment periods - the first being from the date of issuance to the end of that first partial month, the second being all full months starting on the 1st through the 30th (or 31st, if applicable), and the third being for the last partial month of the issuance where the enrollment period would be from the 1st of the month to the last date of issuance.

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