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 perform line level adjudication for Professional Claims. As such, voids can be performed on the line and claim level. However the EDGE Server Business Rules (ESBR) indicate that Voids and Replacements are performed at the Claim Header Level. Are issuers to report each claim line at the claim header level?

Answer: EDGE Server Medical Claim Submission (ESMCS) files must include both the claim header and the claim lines associated with the claim header. Since every claim submitted requires both a header level and claim line detail level, any void or replacement of a claim, even if only a single claim line is adjusted, must also include both the header and line level components. For example if issuers update a single claim line of claim, issuers would have to submit a replacement claim that contains the updated information for the modified claim line or submit a void claim to void the original claim and then submit a new claim that contains updated claim line information in addition to all of the other claim lines from the original claim.

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