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

Guidance for FAQ regarding Edge Server Operations and Data Submission - Enrollment File

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

Question: Are issuers required to submit terminated members, as well as current enrollments on a monthly basis?

Answer: In accordance with the general enrollment file submission rules, the initial enrollment file will be a cumulative file of all of the issuer's enrollees and enrollment periods. Subsequent enrollment file submissions must be a COMPLETE REPLACEMENT FILE inclusive of all enrollees and enrollment periods. Issuers should continue to submit prior year enrollment data, each year, until the Centers for Medicare & Medicaid Services (CMS) notifies issuers to cease such submissions. In regard to terminated enrollees, the EDGE Server Business Rules (ESBR) state, an enrollee or associated enrollment period that is no longer included on a newly submitted file will be inactivated. Inactivated enrollee records and the associated enrollment periods will no longer be eligible for consideration in the RA or RI programs. In addition, any claims associated with that enrollee or enrollment periods will be orphaned and not included in RA or RI calculations. For more information, please refer to the EDGE Server Business Rules (ESBR), located under the Distributed Data Collection (DDC) Program Area at https://www.REGTAP.info in the Registration for Technical Assistance Portal (REGTAP) Library.