Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 37

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3/31 Column – Part 2, Lines 2.1b + 2.2b + 2.4b + 2.6b – 2.7 + 2.8b + 2.9b + 2.11a + 2.11b – 2.12a
+ 2.13 + 2.14 + 2.15
(Note: Allowable fraud reduction expenses are added to Incurred Claims in the calculation of
Adjusted Incurred Claims in Part 3, Line 1.2.)
Line 2.17 – Allowable claims recovered through fraud reduction efforts
Report the amount of claims payments recovered through fraud reduction efforts not to exceed the
amount of fraud reduction expenses.
This amount is limited to the lesser of the total fraud reduction expenses reported on Line 2.17a or
the actual fraud recoveries collected on paid claims on Line 2.17b. If either Line 2.17a or Line
2.17b is equal to zero (0) then the allowable amount is equal to zero (0).
2.17a – Total fraud reduction expense.
2.17b – Total fraud recoveries that reduced PAID claims in Part 2, Line 2.1.
Include collected fraud recoveries on paid claims only.
Line 2.18 – Reconciled Payments of Cost-sharing Reductions
3/31 Column – Include the total reconciled cost-sharing reductions amount for the 2015 benefit
year (MLR reporting year).
[RC] 3/31 Column – Include:
• The reconciled cost-sharing reductions amount for the 2015 benefit year (as reported to the
issuer by CMS); minus
• The difference between the cost-sharing reductions amount for the 2014 benefit year that
was reported by the issuer on the 2014 MLR Form and the reconciled cost-sharing
reductions amount for the 2014 benefit year (as reported to the issuer by CMS).
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