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.


956 CMR 13.03
Adopted by Mass Register Issue 1285, eff. 4/24/2015.

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