Reinsurance (RP) FAQ
Guidance for FAQ regarding Payment and Reports
Program Area: Reinsurance (RP)
Question: Is there a difference between the Risk Adjustment (RA) and Reinsurance (RI) reports that are generated by the issuer, in comparison to those that are generated by the Centers for Medicare & Medicaid Services (CMS)?
Answer: Provided that the enrollment/claims data and EDGE server version are the same, the only difference between EDGE outbound reports generated by the issuer and those generated from CMS report commands is that locally-generated outbound reports have 'L' in the filename; otherwise, the calculations and XML data elements are the same. Note, however, that CMS does not receive issuer-generated reports, with the exception of Enrollee (Without) Claims Summary and (ECS) Reports run in the production environment. All other CMS reports are summary-level.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: March 04, 2015
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