956 CMR, § 13.08 - Risk Adjustment Data Validation
(1)
The Connector will employ a Risk Adjustment Data Validation (RADV) program,
under which a statistically valid sample of risk adjustment data from each
Carrier will be validated. Each Carrier must comply with the Connector 's RADV
procedures as laid out in applicable regulation, administrative bulletin, or
other guidance.
(2) A Carrier must
supply the Connector or the Connector 's designee with all relevant source
enrollment documentation, all claims and encounter data, and medical record
documentation from providers of services to each enrollee in the applicable
sample without unreasonable delay and in a manner that reasonably assures
confidentiality and security in transmission.
Notes
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