Can the MAO or other entity populate the encounter data record with demographic information related to age, name, and sex that it knows to be correct, or should it only submit data sent to the MAO or other entity by the provider (which might be incorrect)?


Answer:

The Encounter Data Record (EDR) is a report to CMS from the MAO or other entity about an item or service received by the plan enrollee. The MAO or other entity should populate the EDR with demographic information related to age, name, and sex using data that it knows to be correct, instead of submitting to CMS incorrect data that a provider submitted to the MAO or other entity on a claim for payment.

Source: CMS HPMS Memo with subject “Guidance for Encounter Data Submission” (October 30, 2017)

Last Updated: 10/30/2017