Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server FAQ
Guidance for FAQ regarding Edge Server Operations and Data Elements
Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server
Question: In order to replace a previously submitted claim with an incorrect enrollee ID number, can the issuer resubmit the claim with the same claim number and an 'R=Replacement' indicator?
Answer: As noted in the Edge Server Business Rules (available in the REGTAP Library at https://www.REGTAP.info), in order to replace a previously submitted medical or pharmacy claim, the claim must be resubmitted with the original claim number and the replace indicator (R) in the Void/Replace indicator data field. If multiple claims exist on the stored medical claim table, either in an active or inactive status, any claim ID may be used as the Original Claim ID to replace the most current active version of a claim. The Edge Server searches the database for a claim that matches the original claim number. If a match is found, the original claim is made inactive and the replacement claim is added as the new active version of that claim.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 03, 2013
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