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Insurers can't correct certain data filing errors, CMS bulletin says

September 4, 2015 | By
Tools

In a recent bulletin, the federal government addresses incorrect data submission under the Affordable Care Act's reinsurance and risk adjustment programs for the 2014 benefit year. As the Centers for Medicare & Medicaid Services (CMS) notes, "an overstatement or understatement of diagnoses or other factors driving an issuer's risk score will have a uniform effect on the risk adjustment transfers for the other issuers in the market." Insurers that provided incorrect claims or diagnosis data cannot change that at this point, as it unlikely to negatively affect other insurers and "our EDGE server deadlines have been clear," the bulletin states. However, "in cases where there is a material impact on risk adjustment transfers for that particular market as a result of incorrect EDGE server premium data," CMS will take steps to correct the inbalance. Announcement

 
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