Section Ins 4006.04 - Observation Period for Record Selection (a) Carriers and third-party administrators shall submit a member eligibility file that contains data for each member eligible for medical, dental, or pharmacy benefits for one or more dates of coverage at any time during a reporting month as well as any retrospective updates that correspond to previously submitted eligibility data. It shall include benefits, attributes, and associated effective periods. (b) Carriers and third-party administrators shall include all claims adjudicated during the reporting month for all members in the member eligibility file for that month. (c) Carriers' and third-party administrators' data submissions shall contain 180 days claims run out for members in all current or previously submitted files.N.H. Admin. Code § Ins 4006.04
Derived From Volume XXXV Number 32, Filed August 13, 2015, Proposed by #10877, Effective 7/10/2015, Expires7/10/2025.Amended by Volume XL Number 50, Filed December 10, 2020, Proposed by #13136, Effective 11/24/2020, Expires 11/24/2030