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

Issue Date: November 04, 2015

Program Area: Vendor Management, Payments, and Collections (VMPC)

Question: When a Health Insurance Casework System (HICS) case that has a rating defect or resolved rating defect appear on the Preliminary Payment Report (PPR) and HIX 820 transaction?

Answer: Once the rating defect is resolved, the Centers for Medicare & Medicaid Services (CMS) will reverse any incorrect payments and pay the proper amount. The reversal and payments will correspond to the relevant coverage months.

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