Section Ins 19.22 - WIHSP payment reconciliation The reconciliation period in this section means the time between June 30, or the date the commissioner notifies eligible health carriers of reinsurance payments, through December 31, of the calendar year following the applicable benefit year. For example, the reconciliation period for benefit year 2019 starts June 30, 2020, and continues through December 31, 2020. The following provisions apply during the reconciliation period:
(1) Eligible health carriers that receive additional adjustments in claim payments or identify additional data corrections during the reconciliation period shall notify the commissioner within 30 days of identifying the overpayment or no later than December 31. If the adjustment or data correction resulted in a WIHSP overpayment, the eligible health carrier shall fully identify the claim, the amount of overpayment, and either of the following as applicable:(a) For eligible health carriers submitting claims for reinsurance payment during the benefit year in which the reconciliation occurs, the commissioner may reduce that benefit year's reinsurance payment by the amount of overpayment.(b) If a health carrier does not submit claims for reinsurance payment during the benefit year in which the reconciliation occurs, the amount of overpayment shall be remitted to the commissioner at the commissioner's request.(2) If, after June 30 of the reconciliation period, the eligible health carrier determines it underreported eligible claims as a result of claim adjustments or data corrections, the eligible health carrier shall notify the commissioner of the claim adjustments and data correction with supporting documentation as soon as possible. The commissioner may, at the commissioner's sole discretion, provide additional reinsurance payments to the eligible health carrier for the applicable benefit year based on such factors as the reason for the underreporting, the timing of the underreporting and the availability of funds for distribution.(3) If the commissioner identifies an overpayment has occurred to any eligible health carrier the commissioner may order, at the commissioner's sole discretion, either repayment of the amount of the overpayment or may reduce future reinsurance payments to applicable eligible carriers in the amount of the overpayment.Wis. Admin. Code Office of the Commissioner of Insurance Ins 19.22
Adopted by, CR 19-088: cr. Register November 2021 No. 791, eff. 12-1-21; correction in (2) made under s. 35.17, Stats., Register November 2021 No. 791, eff. 12/1/2021