Exception for Non-risk Holders

Problem

If the submitting entity is not a risk holder, many elements do not apply. Should this be handled using an exception request?

Solution

Yes. When a submission is coming from a non‐risk holder (e.g., TPA, claims processer, pharmacy benefits manager, device benefit manager, etc.), several elements may not be available to report. A data exception shall be submitted to identify each unavailable element.  See the Data Exceptions section of the Data Submission Guide. 

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