956 CMR 13.04 - Ongoing Discrepancy Resolution Process

(1) Reports provided to Carriers. During the course of each applicable Benefit Year, CHIA or the Connector will provide Carriers, at a frequency specified by the Connector, with Member Month Tracker Reports and Quarterly Simulation Reports.
(2) Carrier Review of Reports. Within 30 calendar days of receiving either of the reports described in 956 CMR 13.04(1), a Carrier must either:
(a) Confirm to the Connector that the information in the report accurately reflects the data that the Carrier has provided to CHIA for the timeframe specified in the report, or
(b) Identify and report to the Connector with appropriate reporting detail any discrepancy it identifies in the report. The Connector may through guidance provide the manner and format for reporting any discrepancies.
(3) If a Carrier neither confirms that the data are accurate nor reports a discrepancy, the Connector will deem the report to be accurate and that no discrepancies have been identified consistent with 956 CMR 13.04(5).
(4) Efforts to Resolve the Discrepancy. Following the reporting of a discrepancy by the Carrier, the Connector and the Carrier, along with CHIA as appropriate or necessary, will work together to resolve the discrepancy. The Connector may at its discretion work with the Carrier for up to 60 calendar days to seek to resolve the discrepancy, or it may choose to close the case regarding the discrepancy at an earlier time.
(5) Discrepancies Subject to Reconsideration: Any discrepancies that are reported but that remain unresolved after April 30th of the year following the applicable Benefit Year (including discrepancy cases closed by the Connector prior to resolution), or discrepancies that could not have been identified by the Carrier by April 30th, may be addressed through the reconsideration process described in 956 CMR 13.06 and 13.07. Any discrepancy that could have been identified by the Carrier under 956 CMR 13.04(2) but was not so identified and reported to the Health Connector may not be raised in the reconsideration process.

Notes

956 CMR 13.04
Adopted by Mass Register Issue 1285, eff. 4/24/2015.

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