R428-13-3. Submission of Performance Measures

  (1) Each carrier shall compile and submit HEDIS data for the preceding calendar year to the Office by July 1 of each year.

  (2) By January 1 of each year, each carrier shall submit to the Office a plan for creating and providing HEDIS data for the preceding calendar year.

  (3) Each carrier shall contract with an independent audit agency certified by the NCQA to verify the HEDIS data using NCQA HEDIS specifications prior to submitting data to the Office.

  (4) Each carrier may employ the rotation strategy for HEDIS measures developed and updated by NCQA.

  (5) If a carrier presents "Not Reported (NR)" for required measures, it must document why it did not report the required measure.

  (6) Each carrier shall cause its contracted audit agency to submit a copy of the audit agency's final report by August 15 of the submission year to the Office. The final report shall incorporate the carrier's comments.