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

Issue Date: September 17, 2014

Program Area: Small Business Health Options Program (SHOP)

Question: If three employer groups are included in a single 820 payment transaction where one employer has paid in full and the other two employers have negative balances that exceed the payment of the first group, will the issuer receive the payment from the first group or will the Federally-facilitated Small Business Health Options Program (FF-SHOP) net all payments?

Answer: The FF-SHOP will net the amounts together. In this instance, the FF-SHOP will not send a payment for the week. The FF-SHOP will never send a payment to an issuer with an amount less than $0.00. The FF-SHOP will send payment history for these three groups on the next payment file when there is a positive balance.

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