Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Policy
Program Area: Risk Adjustment (RA)
Question: With regard to Enrollment Period Activity Indicator (EPAI) values, if a dependent joins a plan during the renewal period, should the issuer assign a plan renewal value, or a new dependent value, and is there a hierarchy associated with the EPAI?
Answer: If a subscriber adds a dependent to their policy during the renewal period, the dependent would need to have the same EPAI as the subscriber. If this occurs during the renewal period, the value populated should be '021041.' For additional information, please refer to operational guidance related to the Enrollment Period Activity Indicator (EPAI) codes, External Data Gathering Environment (EDGE) Server Premiums, EPAI, and Enrollment Scenarios (9/29/15) available at https://www.REGTAP.info under the Distributed Data Collection program area.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: November 25, 2014
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