Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: November 18, 2014

Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server

Question: If an issuer receives an error report and identifies a necessary change for an entire file (medical, pharmacy or supplemental diagnosis), is there a mechanism within the EDGE server that will allow issuers to resubmit a full replacement rather than void and replace line by line, similar to the enrollment file submission process?

Answer: If issuers receive an error report and need to void or replace claims for an entire file, full file replacement is not an option for medical, pharmacy or supplemental diagnosis resubmission. The claims must be resubmitted with the 'V' or 'R' indicator for each claim. The Centers for Medicare & Medicaid Services (CMS) will allow issuers to purge their data in the test zone of the server in order for their test zone data tables to mirror the production data tables. A script will be provided to issuers to run through MySQL command line interface that will purge their test zone data. Issuers do not need CMS approval to purge test data. With regards to the production zone, in general, all issuers are expected to resolve issues with their stored claims data by submitting void and replacement claims. Issuers must resolve enrollment data issues by submitting full, updated replacement enrollment files. On a case-by-case basis, CMS may approve requests from issuers to purge all of their production zone data. Issuers will have to demonstrate that they have widespread systemic errors in their stored claims data that require complete purging of all their tables. Issuers must submit data purging requests to the Help Desk and get approval from CMS prior to purging production data. In order to maintain the integrity and traceability of the data collection process, issuers will not be allowed to delete or make modifications to individual stored records in the MySQL data tables. CMS will check for changes to the MySQL tables as part of the Reinsurance (RI) and Risk Adjustment (RA) audit process.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.