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Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server FAQ

Guidance for FAQ regarding Edge Server Operations and Policy

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

Question: When should Enrollment Period Activity Indicator (EPAI) codes '001', '021028', '021041', and '021EC' be used?

Answer: Code '001' is used when a change occurs to the policy at the subscriber's level. Examples of changes for when code '001' should be used include a change in the monthly premium amount, a change in the subscriber's rating area (that does not result in a new policy issuance), and the addition of a new policy member. Code '021028' is used to indicate the initial issuance of a policy during the first year of enrollment in an Affordable Care Act (ACA) compliant, Risk Adjustment covered and/or Reinsurance eligible health plan. Code '021041' is used to indicate policy renewal for continuous enrollment in an ACA compliant, Risk Adjustment covered and/or Reinsurance eligible health plan from one year to the next year. Code '021EC' is used to indicate when a new member is added to the subscriber's policy in an ACA compliant, Risk Adjustment covered and/or Reinsurance eligible health plan. For additional information, please refer to operational guidance related to the EPAI codes, EDGE Server Premiums, EPAI, and Enrollment Scenarios (9/29/15) available at https://www.REGTAP.info under the Distributed Data Collection program area.

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

Issue Date: December 10, 2014

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