Code of Massachusetts Regulations
956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY
Title 956 CMR 13.00 - Risk Adjustment Procedures For Small And Non-group Market
Section 13.04 - Ongoing Discrepancy Resolution Process
Current through Register 1531, September 27, 2024
(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:
(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.
