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: If an inpatient claim starts in 2014 but ends in 2015, meaning the discharge date is in 2015, to which year does that claim belong? When should the claim be submitted?

Answer: For both Reinsurance (RI) and Risk Adjustment (RA), claims will be allocated to a benefit year based on the statement covers through date reported on the claim header. Therefore, a claim that starts in 2014 but ends in 2015 will be allocated to the 2015 benefit year. The Centers for Medicare & Medicaid Services (CMS) does not require issuers to submit 2014 and 2015 claims on different submission files. Issuers would submit the claim after final adjudication of the claim has occurred.

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