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 13.08 - Risk Adjustment Data Validation

Universal Citation: 956 MA Code of Regs 956.13

Current through Register 1531, September 27, 2024

(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.

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