Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server FAQ
Guidance for FAQ regarding Edge Server Operations and Data Submission - Other
Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server
Question: In submitting adjusted claims, do issuers use the same Claim ID as the Original Claim ID (i.e., claim 126 replaces claim 126)?
Answer: There are key elements that identify a claim as unique during the void/replace process. For Medical claims they are the Issuer ID and the Original Claim ID. For Pharmacy claims they are the Issuer ID, Fill Date, Dispensing Provider ID Qualifier, Fill Number, Dispensing Provider ID, Dispensing Status and Prescription Service Number. The key elements on a void/replace claim may reference any previously submitted claim. For example, if a medical claim 123 was submitted and later replaced with claim 456. The next void/replace could use either 123 or 456 as the key element. To adjust a claim the void/replace indicator must be present along with the original claim ID or replacement claim ID for a medical claim, or the 7 key data elements for a pharmacy claim.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 09, 2013
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