R590-270-5. APCD Carrier Data Submission Requirements

  (1) An APCD Carrier shall submit complete and accurate data to the APCD as prescribed by R428 rules.

  (2) For any submissions to the APCD on or after January 1, 2015, an APCD Carrier shall include in the medical eligibility file the DSG2.0 Additional Data Elements, which is hereby incorporated by reference and available on the Department's website at insurance.utah.gov.

  (a) The DSG2.0 Additional Data Elements shall be inserted into the medical eligibility file after all existing fields, that is, after field ME899.

  (b) The DSG2.0 Additional Data Elements may be submitted with null values for records that are not subject to risk adjustment as outlined in 45 CFR Section 156.80.

  (3) For any submissions to the APCD on or after January 1, 2015, an APCD Carrier shall submit data to the APCD for non-Utah residents if the individual receives coverage through a risk adjustment covered plan issued to a Utah domiciled small employer group.

  (4)(a) An APCD Carrier shall submit the required data to the APCD by the end of the month following the applicable data month.

  (b) Notwithstanding any exemption or extension requested under R428 rules, an APCD Carrier must provide to the APCD, in production format by August 31,2014, at least all claims adjudicated on or after January 1, 2014 and ending on or before June 30, 2014.

  (5)(a) An APCD Carrier shall submit a one-time supplemental eligibility file to the Office of Health Care Statistics. The supplemental eligibility file shall:

  (i) be a supplement to the monthly medical eligibility file;

  (ii) be submitted through a secure method agreed upon by OHCS;

  (iii) be submitted by November 1, 2014; and

  (iv) have a one to one match to records in the most recent available monthly medical eligibility file submitted to the APCD; and

  (b) The one-time supplemental eligibility file shall follow:

  (i) the record layout in the medical eligibility file in the One-time APCD Supplemental Eligibility File, which is hereby incorporated by reference and available on the Department's website at insurance.utah.gov; or

  (ii) an alternative format as approved by the commissioner.