<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".11" citation="COMAR 10.67.03.11" title_num="10" subtitle_num="67" chapter_num="03" heading="Management Information System and Data Reporting.">
  <text>An MCO applicant shall include in its application the following information or descriptions:</text>
  <paragraph num="A.">
    <text>A description of the applicant's management information system, including, but not limited to:</text>
    <paragraph num="(1)">
      <text>Capacities, including:</text>
      <paragraph num="(a)">
        <text>The ability to generate and transmit electronic claims data consistent with the Medicaid Statistical Information System (MSIS) requirements or successor systems;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The ability to collect and report data on enrollee and provider characteristics and on all services furnished to enrollees through an encounter data system;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The ability to screen the data collected for completeness, logic, and consistency; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The ability to collect and report data from providers in standardized formats using secure information exchanges and technologies utilized for Medicaid quality improvement and care coordination efforts;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Software;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Characteristics; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Ability to interface with other systems;</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A description of the applicant's operational procedures for generating service-specific encounter data;</text>
  </paragraph>
  <paragraph num="C.">
    <text>Evidence of the applicant's ability to report, on a monthly basis, service-specific encounter data in UB04 or CMS1500 format;</text>
  </paragraph>
  <paragraph num="D.">
    <text>A description of the applicant's operational procedures for generating financial reports, including, but not limited to:</text>
    <paragraph num="(1)">
      <text>Annual audits;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Annual financial statements; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Quarterly unaudited financial statements;</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Evidence of the applicant’s ability to collect and report all data necessary to derive indicators for Healthcare Effectiveness Data and Information Set (HEDIS); and</text>
  </paragraph>
  <paragraph num="F.">
    <text>A description of the applicant’s procedures for verifying the accuracy and timeliness of reported data, including data from network providers the MCO was compensating on the basis of capitation payments or other payment arrangements that are not fee-for-service.</text>
  </paragraph>
</regulation>