Medicare-Medicaid Plan (MMP) Encounter Data Reporting
|09/30/2020: CMS released a revised version of the Encounter Submission FAQs for MMPs. More information can be found below.|
MMPs are required to submit one of each of the eight Encounter Data Files to CMS at least once per month. The eight Encounter Data Files are Medicare Institutional (837I), Medicare Professional (837P), Medicare DME (837P DME), Medicaid Institutional (837I), Medicaid Professional (837P), Medicaid DME (837P DME), Medicaid Additional Drugs (NCPDP PA 4.2), and Medicaid Dental Services (837D, if a covered service). MMPs must submit the encounters within 180 days from the ending date of service.
More information on encounter data reporting is available below:
- Encounter Submission FAQs for MMPs Participating in the FAI (09/30/2020) (PDF)
- Timeframes for Testing, Certification, and Submission of Encounter Data by MMPs (4/29/2014) (PDF)
- Additional Guidance for Encounter Data Reporting for MMPs (10/24/2013) (PDF)
- Preliminary Guidance for Encounter Data Reporting for MMPs (07/26/2013 (PDF)) (PDF)