Final

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: Regarding interim bill submission, how should an issuer submit data to the EDGE server if the initial date of service (DOS) on the claim is December 2013, the next claim has a DOS of January 2014, and the final claim has a DOS of February 2014?

Answer: Only plans that meet the Market Reform rules should be submitted to the EDGE server. The service that was covered in 2013 presumably was not under a Market Reform Plan, and therefore that service is not eligible to be submitted. If a plan migrates from a plan that is ineligible to a plan that is eligible to submit data to the EDGE server, the issuer would only submit charges incurred under the plan that was eligible in 2014.

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