Common use of Transparency and Quality Reporting Clause in Contracts

Transparency and Quality Reporting. (a) Pursuant to 45 C.F.R. § 156.220 and Centers for Medicare & Medicaid Services Transparency in Coverage requirements, Contractor shall provide Covered California and Enrollees with information reasonably necessary to provide transparency in Contractor’s coverage, and report to Covered California and Enrollees the data as required by Covered California. This includes disclosing applicable information relating to claims payment policies and practices, periodic financial disclosures, enrollment, disenrollment, claims denials, appeals, rating practices, cost- sharing, payments with regard to any out-of-network coverage, and Enrollee rights. Contractor may include pre-treatment estimates as one method of satisfying this obligation. Contractor shall provide information required under this section to Covered California and Enrollees in plain language. (b) Contractor shall timely respond to an Enrollee’s request for cost sharing information and shall make cost sharing information available to individuals through the internet and pursuant to other means for individuals without internet access in a timely manner.

Transparency and Quality Reporting. (a) Pursuant to 45 C.F.R. § 156.220 and Centers for Medicare & Medicaid Services Transparency in Coverage requirements, Contractor shall provide Covered California and Enrollees with information reasonably necessary to provide transparency in Contractor’s coverage, and report to Covered California and Enrollees the data as required by Covered California. This includes disclosing applicable information relating to claims payment policies and practices, periodic financial disclosures, enrollment, disenrollment, claims denials, appeals, rating practices, cost- cost-sharing, payments with regard to any out-of-network coverage, and Enrollee rights. Contractor may include pre-treatment estimates as one method of satisfying this obligation. Contractor shall provide information required under this section to Covered California and Enrollees in plain language. (b) Contractor shall timely respond to an Enrollee’s request for cost sharing information and shall make cost sharing information available to individuals through the internet and pursuant to other means for individuals without internet access in a timely manner.