June 01, 2015

Mike Adelberg Updates Inside Health Insurance Exchanges on CMS' New EDGE Program

In its May edition, Inside Health Insurance Exchanges provided an update on the process of implementing the new EDGE server program for health insurance carriers. The EDGE server program is designed to collect, compile and analyze claims and enrollment data from health plan providers both inside and outside of public exchanges. The Centers for Medicare and Medicaid Services (CMS) will rely on that data to specify reimbursement amounts through the risk-adjustment program, which was created by the Affordable Care Act (ACA) to moderate risk among all providers (for instance, insurers that take on higher-risk populations will receive greater government reimbursement). Providers that do not submit data to the EDGE program lose out on that reimbursement money.

Carriers were supposed to submit their first wave of EDGE data on Apr. 30, but CMS extended that deadline to May 15 in an Apr. 27 notice. While the EDGE server system was supposed to be up and running in Jan. 2014, Mike Adelberg, senior director for FaegreBD Consulting, said that the recent progress is an an encouraging sign.

"While most [exchange] operations are well into year-two and even year-three for plan management, this is still year-one for EDGE server submissions," Adelberg said. "So, some year-one bumps should be expected. But even with a bump or two, the progress made by CMS and insurers over the last month is remarkable."

If all goes according to plan, insurers will use the EDGE servers to submit data on a monthly basis in 2015.

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