956 CMR, § 13.03 - Requirements for Data Submission
(1)
The Connector will utilize the Risk Adjustment Data Extract provided by CHIA
for risk adjustment operations.
(2)
Each Carrier must comply with requirements for submitting enrollment, claims,
and other data to CHIA, in accordance with
957 CMR 8.00: All
Payer Claims Database (APCD) and Case Mix and Charge Data Submission
and related regulations and guidance and any additional instructions
or guidance provided by the Connector. All applicable data for a Benefit Year
must be submitted by April 30th of the year
following the applicable Benefit Year.
(3) If a Carrier fails to submit data or
submits incomplete or inaccurate date to the MA APCD within the timeframe
required, the Connector may assess a default risk adjustment charge, as
described in
956 CMR
13.05.
(4) The Carrier must comply with all
applicable data privacy and security standards and requirements set forth by
CHIA, by the Connector, or by federal regulators, including standards and
requirements described in the applicable State Payment Notice.
Notes
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