Section 2.08 - Compliance with Data Standards(1)Statistical Plan. The Council shall approve and publish a Statistical Plan.(a) The Statistical Plan shall include the methodology to be used by carriers to create unique member identification numbers.(b) The Statistical Plan shall include the edit specifications that the Council or its designee will use to verify the accuracy of data submissions, as well as the standards that the Council or its designee will use to reject submissions because of excessive errors. The Statistical Plan will specify the format of an edit report displaying detail for all errors found in a submission, as well as a summary report containing certain aggregate data for review and verification. The Council or its designee shall provide these reports to each carrier.(c) The Statistical Plan shall include a method for carriers to submit a limited number of late claims paid during a prior submission period. The Statistical Plan shall include rules for submitting denied claims. The Statistical Plan shall include rules for submitting claims for medical services that include pharmacy codes.(d) The Statistical Plan shall list the HEDIS and CAHPS measures that carriers are required to report.(e) The Council will establish compliance standards for submission of race, ethnicity and language data by Administrative Bulletin.(f) Race, ethnicity and language data submitted by carriers shall be based on data self-reported by the member. Carriers may report race, ethnicity and language data acquired from a third party provided that:1. such data is self-reported by members or guardians; and2. the carrier submits a technical plan to the Council or its designee that specifies how the date was collected by the third party and obtained by the third party.(2)Compliance. The Council, or its designee, shall evaluate each member eligibility file, medical claims file and pharmacy claims file to determine compliance with the Statistical Plan and the data reporting requirements in 129 CMR 2.08(2)(a) through (d):(a) The applicable code for each data element shall be included within the eligible values for the element;(b) Coding values indicating "data not available", "data unknown", or the equivalent shall not be used for individual data elements unless specified as an eligible value for the element, or determined allowable in the Statistical Plan;(c) Member sex, diagnosis and procedure codes, and date of birth and all other data fields shall be consistent within an individual record; and(d) Member identifiers shall be consistent across files.(3)Notification. Upon completion of the evaluation, the Council, or its designee shall promptly notify each carrier whose data submissions do not satisfy the standards. This notification shall identify the specific file and the data elements that do not satisfy the standards.(4)Response. Each carrier notified of a non-compliant data submission shall respond within 60 days of the notification by making the changes necessary to satisfy the standards.