Common use of Contractor’s Responsibilities Clause in Contracts

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. (d) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinationsdeterminations that shall be made for Enrollees by Covered California, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall accept changes to enrollment received from Covered California other than during the Employer’s Open Enrollment period for qualifying events as required under applicable laws, rules and regulations, including those set forth at 45 C.F.R. § 155.330. (d) Contractor shall send enrollment information to Covered California on a daily basis and Contractor shall reconcile enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis. (e) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. .. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request." (df) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (eg) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” ”. Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." ". In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. (d) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall accept changes to enrollment received from Covered California other than during the Employer’s Open Enrollment period for qualifying events as required under applicable laws, rules and regulations, including those set forth at 45 C.F.R. § 155.330. (d) Contractor shall send enrollment information to Covered California on a daily basis and Contractor shall reconcile enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis. (e) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. (df) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (eg) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall accept changes to enrollment received from Covered California other than during the Employer’s Open Enrollment period for qualifying events as required under applicable laws, rules and regulations, including those set forth at 45 C.F.R. § 155.330. (d) Contractor shall send enrollment information to Covered California on a daily basis and Contractor shall reconcile enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis. (e) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor Contract is unable to implement the changes within fifteen ten (1510) business days, the Contractor shall provide written notification to Covered California by the fifteenth tenth (15th10th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days calendar days from Covered California’s request. (d) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinationsdeterminations that shall be made for Enrollees by Covered California, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to the Covered California with evidence the appeal resolution has been implementedimplemented within ten (10) days of receiving all necessary data elements from Covered California required to implement the appeal decision. Contractor shall immediately notify Covered California California, within three (3) days if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall accept changes to enrollment received from Covered California other than during the Employer’s Open Enrollment period for qualifying events as required under applicable laws, rules and regulations, including those set forth at 45 C.F.R. § 155.330. (d) Contractor shall send enrollment information to Covered California on a daily basis and Contractor shall reconcile enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis. (e) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. .. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request." (df) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (eg) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." "". In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. (d) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinationsdeterminations that shall be made for Enrollees by Covered California, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to the Covered California with evidence the appeal resolution has been implementedimplemented within ten (10) days of receiving all necessary data elements from Covered California required to implement the appeal decision. Contractor shall immediately notify Covered California California, within three (3) days if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall accept changes to enrollment received from Covered California other than during the Employer’s Open Enrollment period for qualifying events as required under applicable laws, rules and regulations, including those set forth at 45 C.F.R. § 155.330. (d) Contractor shall send enrollment information to Covered California on a daily basis and Contractor shall reconcile enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis. (e) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. .. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request." (df) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (eg) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall accept changes to enrollment received from Covered California other than during the Employer’s Open Enrollment period for qualifying events as required under applicable laws, rules and regulations, including those set forth at 45 C.F.R. § 155.330. (d) Contractor shall send enrollment information to Covered California on a daily basis and Contractor shall reconcile enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis. (e) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. .. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request." (df) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (eg) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4100503, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinationsdeterminations that shall be made for Enrollees by Covered California, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to the Covered California with evidence the appeal resolution has been implementedimplemented within ten (10) days of receiving all necessary data elements from Covered California required to implement the appeal decision. Contractor shall immediately notify Covered California California, within three (3) days, if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall accept changes to enrollment received from Covered California other than during the Employer’s Open Enrollment period for qualifying events as required under applicable laws, rules and regulations, including those set forth at 45 C.F.R. § 155.330. (d) Contractor shall send enrollment information to Covered California on a daily basis and Contractor shall reconcile enrollment information received from Covered California with Contractor’s enrollment data on a monthly basis. (e) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. .. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request." (df) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (eg) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." ". In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. (d) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall participate in the Reconciliation Process accept changes to review and compare enrollment received from Covered California enrollment reconciliation fileother than during the Employer’s Open Enrollment period for qualifying events as required under applicable laws, distributed monthlyrules and regulations, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s requestthose set forth at 45 C.F.R. § 155.330. (d) Contractor shall participate in a Dispute Process established by send enrollment information to Covered California to resolve issues related to the Reconciliation Process. on a daily basis and Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California reconcile enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California with Contractor’s enrollment data on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor’s Responsibilities. (a) Contractor shall comply with all Federal and State eligibility and enrollment statutes and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code § §100503 and 100503.4, and 10 CCR § 6400 et seq. (b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QDP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. (c) Contractor shall participate in the Reconciliation Process to review and compare Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” ”. Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the Reconciliation Process Guide." ". In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. (d) Contractor shall participate in a Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” (e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Employers or Covered California Enrollees when Covered California notifies or confirms such change to Contractor.