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

956 CMR 13.08
Adopted by Mass Register Issue 1285, eff. 4/24/2015.

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