Common use of Transparency and Quality Reporting Clause in Contracts

Transparency and Quality Reporting. a) Pursuant to 45 CFR § 156.220, Contractor shall provide the Exchange and Enrollees with information reasonably necessary to provide transparency in Contractor’s coverage, and report to the Exchange and Enrollees the data required no later than March 31st of each year. This includes information relating to claims payment policies and practices, financial disclosures, enrollment, disenrollment, denials, rating practices, cost-sharing, out-of-network coverage, and Enrollee rights. Contractor shall provide information required under this Section to the Exchange 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.