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

Issue Date: September 03, 2015

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

Question: Is it an enrollment discrepancy if an Issuer recognizes that the Preliminary Payment Report (PPR) and the Issuer's enrollment information do not match and the Issuer received an overpayment?

Answer: Yes, if the Pre-audit File, the PPR and the Issuer's enrollment information do not match and the Issuer received an overpayment/underpayment, the Issuer should report this event as an enrollment discrepancy. Issuers are allowed to submit a dispute for the overpayment as an incorrect payment dispute type.

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