Section 216-RICR-10-10-5.7 - Compliance with Data Standards5.7.1StandardsA. The Data Aggregator shall evaluate each Member Eligibility File, Provider File, Medical Claims File, Pharmacy Claims File, and Dental File in accordance with the following standards:1. The applicable code for each data element shall be as identified in the RIAPCD Technical Specification Manual and shall be included within eligible values for the element;2. Coding values indicating "data not available," "data unknown," or the equivalent shall not be used for individual data elements unless specified as an eligible value for the element;3. The Encrypted Unique Identifier assigned to each Member shall be consistent across files; and4. Files submitted to the Data Aggregator shall not contain Direct Personal Identifiers.5.7.2NotificationUpon completion of this evaluation, the Director or his or her designee will notify each Insurer whose data submissions do not satisfy the standards for any reporting period. This notification will identify the specific file and the data elements that are determined to be unsatisfactory.
5.7.3ResponseA. Each Insurer notified under § 5.7.2 of this Part shall resubmit within ten (10) business days of the date of notification with the required changes. 1. The Director shall have the discretion to require a response as required by this subsection in a reasonable time commensurate with the level of difficulty for the level of correction required to a data submission.5.7.4ComplianceFailure to file, report, or correct Health Care Claims Data Sets in accordance with the provisions of this Part may be considered a violation of R.I. Gen. Laws Chapter 2317.17 except that an Insurer may seek a variance as specified in § 5.10 of this Part.
216 R.I. Code R. 216-RICR-10-10-5.7
Amended Effective 12/6/2021