W. Va. Code R. § 114A-1-5

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114A-1-5 - Submission Requirements

5.1. Each data submitter shall submit to the Secretary or his or her designee a completed health care claims data set, including a member eligibility file, a medical claims file, a provider file, and a pharmacy claims file for all members who are West Virginia residents, annually or more often as needed, in accordance with the requirements set forth in the Submission Manual.

5.2. If a data submitter is unable to meet the terms and conditions of this rule and the Submission Manual due to circumstances beyond its control, a written request must be made to the Secretary as soon as it is practicable after the data submitter has determined that an extension or waiver is required. The written request shall include the specific requirement to be extended or waived; an explanation of the cause; the methodology proposed to eliminate the necessity of the extension or waiver; and the time frame required to come into compliance. The decision of the Secretary is not subject to further review.