New Enrollee-level EDGE Data Now Available

CMS is pleased to announce the availability of the Enrollee-Level External Data Gathering Environment (EDGE) Limited Data Set (LDS) for the 2016 benefit year. The EDGE LDS contains enrollment and claims data for on- and off-Exchange enrollees in risk adjustment covered plans in the individual and small group markets, in states where HHS operated the risk adjustment program for the 2016 benefit year. HHS operated the risk adjustment program for all states and the District of Columbia, with the exception of Massachusetts, for the 2016 benefit year. The dataset is composed of 4 data files: enrollment, medical claims, pharmaceutical claims, and supplemental claims. The data elements document, posting today, provides the data elements that are included in the 2016 benefit year enrollee-level EDGE LDS. The data creation guide explains the methods, decisions, and key steps taken in creating the 2016 benefit year EDGE LDS. The EDGE LDS file includes masked randomly generated enrollee numbers to link the enrollment and claims data for each enrollee. Issuers do not submit data on enrollees’ direct identifiers to their EDGE servers; therefore the EDGE LDS does not include any personally identifiable data.

The EDGE LDS can be requested through the usual CMS LDS process, found on the CMS LDS website.