Section Ins 19.12 - Final annual report and affirmations(1) Eligible health carriers shall provide a final annual report to the commissioner by or before May 15 of each calendar year after the applicable benefit year, or a date established by the commissioner. The final annual report shall be completed using data as submitted to CMS through the health carrier's EDGE server that is compliant with all applicable EDGE server requirements. In the event the EDGE server data is no longer available, the eligible health carrier shall use data extracted from the health carrier's claims systems or similar database that tracks enrolled insured's validated claims.(2) The final annual report shall be transmitted to the commissioner through a secure FTP in a format designated by the commissioner. Instructions for submission of required information shall be provided to the eligible health carriers by the commissioner. The information shall include all of the following:(a) The final total number of enrolled individuals for the applicable benefit year utilizing the same unique identifiers as contained in quarterly reports.(b) The final total dollar amount of claims incurred in the applicable benefit year that were paid by the eligible health carrier no later than April 30 of the next calendar year, or a date established by the commissioner.(c) The final dollar amount of eligible claims for each identified enrolled individual.(d) Any additional information requested by the commissioner.(3) An authorized representative of the eligible health carrier shall complete a report affirming the data was derived from the EDGE server and is accurate, in compliance with the EDGE server business rules and s. 601.83, Stats. The affirmation shall be transmitted to the commissioner by or before May 15, or a date established by the commissioner, of each calendar year after the applicable benefit year in a format designated by the commissioner. Instructions for submission of required information shall be provided to the eligible health carriers by the commissioner.(4)(a) An authorized officer of the eligible health carrier shall attest to the carrier's compliance with s. 601.83, Stats., in a format designated by the commissioner. Instructions for submission of required information shall be provided to the eligible health carrier by the commissioner. The information shall include all of the following: 1. An attestation that the information provided to the commissioner is accurate, included only eligible claims and was derived from EDGE server data.2. An attestation that the information contained the same unique identifiers for enrolled individuals as reported in quarterly or annual reports.3. A copy of the Attestation and Discrepancy Reporting Summary confirmation page as reported to CMS. If the Attestation and Discrepancy Reporting Summary contained a dispute, the eligible health carrier shall provide documentation of the disputed data and identify the claims in dispute with the enrolled individual's unique identifier.4. An acknowledgment that the eligible health carrier will not receive a reinsurance payment in the event that WIHSP authorizing statute is amended in a manner that no reinsurance payment is due to any carriers.5. An acknowledgment, in accordance with s. 601.83(5) (h), Stats., that the eligible health carrier shall not bring a lawsuit over any delay in reinsurance payments or reduction in expected reinsurance payments.6. Any additional information required by the commissioner.(b) The eligible health carrier shall transmit the information to the commissioner by or before May 15, of each calendar year after the applicable benefit year, or by a date established by the commissioner.Wis. Admin. Code Office of the Commissioner of Insurance Ins 19.12
Adopted by, CR 19-088: cr. Register November 2021 No. 791, eff. 12-1-21; correction in (1) made under s. 35.17, Stats., Register November 2021 No. 791, eff. 12/1/2021