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 13.06 - 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:

(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.