956 CMR 13.06 - Request for Reconsideration

(1) Grounds for Reconsideration Request. A Carrier may request reconsideration of the Final Risk Adjustment Payments and Charges Report only with respect to the following:
(a) An incorrect application by the Connector of the risk adjustment methodology, including issues related to unresolved data discrepancies; or
(b) Mathematical error.
(2) Risk Adjustment Methodology . The risk adjustment methodology cannot be the subject of a request for reconsideration.
(3) Materiality Threshold. Notwithstanding 956 CMR 13.06(1), a Carrier may file a request for reconsideration under 956 CMR 13.06 only if the amount in dispute is equal to or exceeds one percent of the applicable payment or charge listed in the Final Risk Adjustment Payments and Charges Report, or $10,000, whichever is less.
(4) Time for Filing Request for Reconsideration. The request for reconsideration must be filed within 30 calendar days after issuance of the Final Risk Adjustment Payments and Charges Report.
(5) Manner and Content of Reconsideration Request. The request for reconsideration must be in writing. It must specify the calculations or issues that the Carrier is challenging, the reasons for the challenge, and the amount of money that is in dispute. The Carrier must include in the request for reconsideration any additional documentary evidence that supports its request. The Carrier may not submit in evidence any data that could have been submitted during the discrepancy resolution process, but that was not timely submitted.
(6) Reconsideration Does Not Stay Obligation to Pay. The filing of a request for reconsideration shall not stay either the obligation to pay a risk adjustment charge, or the accrual of interest for late payment.


956 CMR 13.06
Adopted by Mass Register Issue 1285, eff. 4/24/2015.

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