Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server FAQ
Guidance for FAQ regarding Edge Server Operations and Data Submission - Medical File
Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server
Question: What value should capitated issuers use to populate the Amount Allowed field?
Answer: Capitated providers who do not capture an Amount Allowed value, must populate the Amount Allowed fields on the inbound pharmacy and medical claim files with a value greater than $1.00. Capitated issuers do not need to derive the Amount Allowed and may use a default value of $1.00 for all claims submitted. Capitated providers must derive all paid amounts for submitted pharmacy and medical claims.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: November 18, 2014
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