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: Can the Centers for Medicare & Medicaid Services (CMS) provide additional information on the submission of non-standalone dental claims?

Answer: Standalone dental is excluded from the Risk Adjustment (RA) and Reinsurance (RI) programs but issuers who provide dental services as part of a small group or individual market plan should submit dental services to the EDGE server for consideration. Issuers should use Service Code Qualifier '01' to indicate a dental service is being submitted. Issuers should also include the appropriate dental service code in the Service Code Qualifier field.

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