Medicare-Medicaid Plan (MMP) Encounter Data Reporting
Guidance for Medicare-Medicaid Plan (MMP) Encounter Data Reporting.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 08, 2020
MMPs are required to submit one of each of the eight Encounter Data Files to CMS at least once per month. The eight Encounter Data Files are Medicare Institutional (837I), Medicare Professional (837P), Medicare DME (837P DME), Medicaid Institutional (837I), Medicaid Professional (837P), Medicaid DME (837P DME), Medicaid Additional Drugs (NCPDP PA 4.2), and Medicaid Dental Services (837D, if a covered service). MMPs must submit the encounters within 180 days from the ending date of service.
More information on encounter data reporting is available below:
- Encounter Submission FAQs for MMPs Participating in the FAI (09/30/2020) (PDF)
- Timeframes for Testing, Certification, and Submission of Encounter Data by MMPs (4/29/2014) (PDF)
- Additional Guidance for Encounter Data Reporting for MMPs (10/24/2013) (PDF)
- Preliminary Guidance for Encounter Data Reporting for MMPs (07/26/2013 (PDF)) (PDF)
Want regular email updates? Sign up by visiting this link.
We’re always looking for ways to improve the experience and usability of our webpages. If you’ve Feedback or issues to report, please contact us at MMCOWeb@cms.hhs.gov.
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.