Common use of Interim Settlement Clause in Contracts

Interim Settlement. CMS and EOHHS shall determine an interim settlement based on three (3) months of claims run‑out beyond the end of Demonstration Year 1 and an incurred but not reported (IBNR) estimate. For the purpose of the interim settlement, the Contractor will jointly provide to CMS and EOHHS the following within 120 calendar days following the end of each Demonstration Year: A complete and accurate report of Actual Non‑Service Expenditures for Enrollees in the Demonstration Year; A complete and accurate report of Actual Service Expenditures, based on category of services, for Enrollees based on claims incurred for the Demonstration Year, including three (3) months of claims run‑out; The Contractor’s best estimate of any claims incurred but not reported (XXXX) for claims run‑out beyond three (3) months and any IBNR completion factors by category of service; A complete and accurate report of Part D revenue and expenditure, as required under 42 C.F.R. 423.514(a)(1); A complete and accurate report reflecting any recoveries from other payors outside of claims adjudication that are not reflected in the reported Actual Service Expenditures, including those pursuant to coordination of benefits, third party liability, rebates, supplemental payments, adjustments in claims paid, adjustments from providers including adjustments to claims paid, and Enrollee contributions to care (as described in Section 4.4.3.); A complete and accurate report of net reinsurance costs that are included in the reported Actual Non‑Service Expenditures; Encounter Data, as required under Section 2.17 of this Contract, unless otherwise permitted by CMS and MassHealth; and A completed electronic funds transfer authorization agreement. CMS and EOHHS shall provide the Contractor with an interim reconciliation under the risk corridor arrangement within one‑hundred fifty (150) calendar days following the end of the Demonstration Year, unless otherwise permitted by CMS. Any balance due between the Contractor and CMS and EOHHS shall be paid within sixty (60) days of the Contractor receiving the Interim Reconciliation from CMS and EOHHS. The Contractor shall provide any additional information upon request from CMS and EOHHS necessary to calculate Total Adjusted Expenditures.

Interim Settlement. CMS and EOHHS shall determine an interim settlement based on three (3) 3 months of claims run‑out run-out beyond the end of Demonstration Year 1 and an incurred but not reported (IBNR) estimate. For the purpose of the interim settlement, the Contractor will jointly provide to CMS and EOHHS the following within 120 calendar days following the end of each Demonstration Year: A complete and accurate report of Actual Non‑Service Non-Service Expenditures for Enrollees in the Demonstration Year; A complete and accurate report of Actual Service Expenditures, based on category of services, for Enrollees based on claims incurred for the Demonstration Year, including three (3) 3 months of claims run‑outrun-out; The Contractor’s Contractor‘s best estimate of any claims incurred but not reported (XXXX) for claims run‑out run-out beyond three (3) 3 months and any IBNR completion factors by category of service; A complete and accurate report of Part D revenue and expenditure, as required under 42 C.F.R. 423.514(a)(1); A complete and accurate report reflecting any recoveries from other payors outside of claims adjudication that are not reflected in the reported Actual Service Expenditures, including those pursuant to coordination of benefits, third party liability, rebates, supplemental payments, adjustments in claims paid, adjustments from providers including adjustments to claims paid, and Enrollee contributions to care (as described in Section 4.4.3.); A complete and accurate report of net reinsurance costs that are included in the reported Actual Non‑Service Non- Service Expenditures; Encounter Data, as required under Section 2.17 of this Contract, unless otherwise permitted by CMS and MassHealth; and A completed electronic funds transfer authorization agreement. CMS and EOHHS shall provide the Contractor with an interim reconciliation under the risk corridor arrangement within one‑hundred one-hundred fifty (150) calendar days following the end of the Demonstration Year, unless otherwise permitted by CMS. Any balance due between the Contractor and CMS and EOHHS shall be paid within sixty (60) days of the Contractor receiving the Interim Reconciliation from CMS and EOHHS. The Contractor shall provide any additional information upon request from CMS and EOHHS necessary to calculate Total Adjusted Expenditures.

Interim Settlement. CMS and EOHHS shall determine an interim settlement based on three (3) 3 months of claims run‑out run-out beyond the end of Demonstration Year 1 and an incurred but not reported (IBNR) estimate. For the purpose of the interim settlement, the Contractor will jointly provide to CMS and EOHHS the following within 120 calendar days following the end of each Demonstration Year: A complete and accurate report of Actual Non‑Service Non-Service Expenditures for Enrollees in the Demonstration Year; A complete and accurate report of Actual Service Expenditures, based on category of services, for Enrollees based on claims incurred for the Demonstration Year, including three (3) 3 months of claims run‑outrun-out; The Contractor’s best estimate of any claims incurred but not reported (XXXXIBNR) for claims run‑out run-out beyond three (3) 3 months and any IBNR completion factors by category of service; A complete and accurate report of Part D revenue and expenditure, as required under 42 C.F.R. 423.514(a)(1); A complete and accurate report reflecting any recoveries from other payors outside of claims adjudication that are not reflected in the reported Actual Service Expenditures, including those pursuant to coordination of benefits, third party liability, rebates, supplemental payments, adjustments in claims paid, adjustments from providers including adjustments to claims paid, and Enrollee contributions to care (as described in Section 4.4.3.); A complete and accurate report of net reinsurance costs that are included in the reported Actual Non‑Service Non-Service Expenditures; Encounter Data, as required under Section 2.17 of this Contract, unless otherwise permitted by CMS and MassHealth; and A completed electronic funds transfer authorization agreement. CMS and EOHHS shall provide the Contractor with an interim reconciliation under the risk corridor arrangement within one‑hundred one-hundred fifty (150) calendar days following the end of the Demonstration Year, unless otherwise permitted by CMS. Any balance due between the Contractor and CMS and EOHHS shall be paid within sixty (60) days of the Contractor receiving the Interim Reconciliation from CMS and EOHHS. The Contractor shall provide any additional information upon request from CMS and EOHHS necessary to calculate Total Adjusted Expenditures.

Interim Settlement. CMS and EOHHS shall determine an interim settlement based on three (3) 3 months of claims run‑out beyond the end of Demonstration Year 1 and an incurred but not reported (IBNR) estimate. For the purpose of the interim settlement, the Contractor will jointly provide to CMS and EOHHS the following within 120 calendar days following the end of each Demonstration Year: A complete and accurate report of Actual Non‑Service Expenditures for Enrollees in the Demonstration Year; A complete and accurate report of Actual Service Expenditures, based on category of services, for Enrollees based on claims incurred for the Demonstration Year, including three (3) 3 months of claims run‑out; The Contractor’s best estimate of any claims incurred but not reported (XXXXIBNR) for claims run‑out beyond three (3) 3 months and any IBNR completion factors by category of service; A complete and accurate report of Part D revenue and expenditure, as required under 42 C.F.R. 423.514(a)(1); A complete and accurate report reflecting any recoveries from other payors outside of claims adjudication that are not reflected in the reported Actual Service Expenditures, including those pursuant to coordination of benefits, third party liability, rebates, supplemental payments, adjustments in claims paid, adjustments from providers including adjustments to claims paid, and Enrollee contributions to care (as described in Section 4.4.3.); A complete and accurate report of net reinsurance costs that are included in the reported Actual Non‑Service Expenditures; Encounter Data, as required under Section 2.17 of this Contract, unless otherwise permitted by CMS and MassHealth; and A completed electronic funds transfer authorization agreement. CMS and EOHHS shall provide the Contractor with an interim reconciliation under the risk corridor arrangement within one‑hundred fifty (150) calendar days following the end of the Demonstration Year, unless otherwise permitted by CMS. Any balance due between the Contractor and CMS and EOHHS shall be paid within sixty (60) days of the Contractor receiving the Interim Reconciliation from CMS and EOHHS. The Contractor shall provide any additional information upon request from CMS and EOHHS necessary to calculate Total Adjusted Expenditures.