Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 05, 2014

Program Area: Small Business Health Options Program (SHOP)

Question: If an issuer received a misdirected 820 payment from the Small Business Health Options Program (SHOP), is the issuer responsible for distributing those funds back to the SHOP or would the SHOP recoup the funds through the 820 transaction process?

Answer: While this scenario is highly unlikely, if this scenario were to occur, the Centers for Medicare & Medicaid Services (CMS) would fix the situation on the next weekly issuer payment cycle and note the adjustments on associated 820 transactions.

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