Common use of Contractor Responsibilities Clause in Contracts

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. ‌ a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” ”. Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." ”. In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS the CCSB eligibility and enrollment system that result from an applicantEmployer’s appeal of an a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee an Employee and/or Dependent requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees Employees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in input the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the information into Contractor’s membership enrollment and financial databases. Contractor shall review and reconcile its membership enrollment and financial databases with Covered California enrollment reconciliation file on a monthly basis. Contractor will use the Monthly Reconciliation File provided by Covered California in an EDI or CSV format to perform eligibility and financial validation and reconciliation. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide between Covered California with evidence through email confirmation that the enrollment and Contractor. The eligibility and/or financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor discrepancies shall provide written notification be reported to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s requestvia FTP. d) Contractor will follow the discrepancy reconciliation process mutually developed with Covered California and their enrollment vendor. Contractor will work to receive all data reconciliation files electronically to expedite and automate data reconciliation. If a discrepancy is detected, CCSB will notify Contractor and note discrepancies on the daily reconciliation report until resolved. Contractor will make all efforts to prioritize reconciliation of enrollment data discrepancies that may lead to subscriber or dependent Access to Care (ATC) events. These data points include member effective date, member enrollment status, member Date of Birth (DOB) or other related demographic data which would impact Access to Care (ATC) for services. For the purpose of monitoring discrepancies and preventing member access to care events, CCSB will monitor and report all discrepancies until the discrepancy is reconciled. e) Contractor shall participate in the Dispute Process established ingest Standard X12 EDI benefit enrollment and maintenance set files (834) furnished by Covered California and ensure Interchange acknowledgement files (999/TA1) are transmitted between Contractor and Covered California in a mutually agreed format. This includes all X12 response files (834 effectuation, TA1/999, etc.). f) Once the 834 File has been sent to resolve issues related to Contractor, Covered California should receive a 999/TA1 Acknowledgement File in return from the Reconciliation ProcessContractor, confirming the 834 File has been received. Contractor shall submit adhere to the agreed upon turn-around time (TAT) for processing 834 Files to add a new member. Contractor shall send Covered California the return 834 Effectuation File which will include the member’s information and the Contractor assigned member ID number. After Covered California receives the 834 Effectuation File from Contractor, Covered California shall send Contractor a 999/TA1 Acknowledgement File confirming Contractor’s file was received and processed. g) After Covered California has sent the monthly 820 Payment Remittance File to Contractor, Contractor shall send a 999/TA1 Acknowledgement File confirming the 820 File was received and processed. h) Contractor shall provide a supplemental file to dispute for those members with identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The discrepancies. Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to provide this file within two weeks of the Center for Medicaid and Medicare Services or receipt of the Center for Consumer Information and Health Insurance Oversightweekly reconciliation file. ei) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees Employers or Employees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. ‌ a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including including, but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS the CCSB eligibility and enrollment system that result from an applicantEmployer’s appeal of an a Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee an Employee and/or Dependent requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees Employees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in input the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the information into Contractor’s membership enrollment and financial databases. Contractor shall review and reconcile its membership enrollment and financial databases with Covered California enrollment reconciliation file on a monthly basis. The Contractor will use the Monthly Reconciliation File provided by Covered California in an EDI or CSV format to perform eligibility and financial validation and reconciliation. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide between Covered California with evidence through email confirmation that the enrollment and Contractor. The eligibility and/or financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor discrepancies shall provide written notification be reported to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s requestvia FTP. d) Contractor shall participate in the Dispute Process established ingest Standard X12 EDI benefit enrollment and maintenance set files (834) furnished by Covered California to resolve issues related and ensure Interchange acknowledgement files (999/TA1) are transmitted between Contractor and Covered California in a mutually agreed format. This includes all X12 response files (834 effectuation, TA1/999, etc.). e) Once the 834 File has been sent to the Reconciliation ProcessContractor, Covered California should receive a 999/TA1 Acknowledgement File in return from the Contractor, confirming the 834 File has been received. The Contractor shall adhere to the agreed upon turn-around time (TAT) for processing 834 Files to add a new member. Contractor shall submit send Covered California the return 834 Effectuation File which will include the member’s information and the Contractor assigned member ID number. After Covered California receives the 834 Effectuation File from the Contractor, Covered California shall send the Contractor a 999/TA1 Acknowledgement File confirming the Contractor’s file was received and processed. f) After Covered California has sent the monthly 820 Payment Remittance File to the Contractor, the Contractor shall send a 999/TA1 Acknowledgement File confirming the 820 File was received and processed. g) Contractor shall provide a supplemental file to dispute for those members with identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The discrepancies. Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to provide this file within two weeks of the Center for Medicaid and Medicare Services or receipt of the Center for Consumer Information and Health Insurance Oversightweekly reconciliation file. eh) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees Employers or Employees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including including, but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request." d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: : (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an ▇▇▇ Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a an Covered California Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor Contract is unable to implement the changes within fifteen ten (1510) business days, the Contractor shall provide written notification to Covered California by the fifteenth tenth (15th10th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days calendar days from Covered California’s request. d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including including, but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an Covered California determination. . Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. . Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. . In the event that a Covered California an Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. . Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. . c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. . Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. . Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. . Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor Contract is unable to implement the changes within fifteen ten (1510) business days, the Contractor shall provide written notification to Covered California by the fifteenth tenth (15th10th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days calendar days from Covered California’s request. d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. . Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. . e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including including, but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS the CCSB eligibility and enrollment system that result from an applicantEmployer’s appeal of an a Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have within ten (10) days of receiving all necessary data elements from Covered California required for the Contractor to implement the appeal appeals decision. In the event that a Covered California Enrollee an Employee and/or Dependent requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees Employees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in input the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the information into Contractor’s membership enrollment and financial databases. Contractor shall review and reconcile its membership enrollment and financial databases with Covered California enrollment reconciliation file on a monthly basis. The Contractor will use the Monthly Reconciliation File provided by Covered California in an EDI or CSV format to perform eligibility and financial validation and reconciliation. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide between Covered California with evidence through email confirmation that the enrollment and Contractor. The eligibility and/or financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor discrepancies shall provide written notification be reported to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s requestvia FTP. d) Contractor shall participate in the Dispute Process established ingest Standard X12 EDI benefit enrollment and maintenance set files (834) furnished by Covered California to resolve issues related and ensure Interchange acknowledgement files (999/TA1) are transmitted between Contractor and Covered California in a mutually agreed format. This includes all X12 response files (834 effectuation, TA1/999, etc.). e) Once the 834 File has been sent to the Reconciliation ProcessContractor, Covered California should receive a 999/TA1 Acknowledgement File in return from the Contractor, confirming the 834 File has been received. The Contractor shall adhere to the agreed upon turn-around time (TAT) for processing 834 Files to add a new member. Contractor shall submit send Covered California the return 834 Effectuation File which will include the member’s information and the Contractor assigned member ID number. After Covered California receives the 834 Effectuation File from the Contractor, Covered California shall send the Contractor a 999/TA1 Acknowledgement File confirming the Contractor’s file was received and processed. f) After Covered California has sent the monthly 820 Payment Remittance File to the Contractor, the Contractor shall send a 999/TA1 Acknowledgement File confirming the 820 File was received and processed. g) Contractor shall provide a supplemental file to dispute for those members with identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The discrepancies. Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to provide this file within two weeks of the Center for Medicaid and Medicare Services or receipt of the Center for Consumer Information and Health Insurance Oversightweekly reconciliation file. eh) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees Employers or Employees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including including, but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an Covered California determination. Within ten (10) Days days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. within ten (10) days of receiving all necessary data elements from Covered California required to implement the appeals decision. Contractor shall immediately notify Covered California , within three (3) days, if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request." d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: : (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request. d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS the CCSB eligibility and enrollment system that result from an applicantEmployer’s appeal of an a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California Enrollee an Employee and/or Dependent requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees Employees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in input the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the information into Contractor’s membership enrollment and financial databases. Contractor shall review and reconcile its membership enrollment and financial databases with Covered California enrollment reconciliation file on a monthly basis. The Contractor will use the Monthly Reconciliation File provided by Covered California in an EDI or CSV format to perform eligibility and financial validation and reconciliation. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide between Covered California with evidence through email confirmation that the enrollment and Contractor. The eligibility and/or financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor discrepancies shall provide written notification be reported to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s requestvia FTP. d) Contractor shall participate in the Dispute Process established ingest Standard X12 EDI benefit enrollment and maintenance set files (834) furnished by Covered California to resolve issues related and ensure Interchange acknowledgement files (999/TA1) are transmitted between Contractor and Covered California in a mutually agreed format. This includes all X12 response files (834 effectuation, TA1/999, etc.). e) Once the 834 File has been sent to the Reconciliation ProcessContractor, Covered California should receive a 999/TA1 Acknowledgement File in return from the Contractor, confirming the 834 File has been received. The Contractor shall adhere to the agreed upon turn-around time (TAT) for processing 834 Files to add a new member. Contractor shall submit send Covered California the return 834 Effectuation File which will include the member’s information and the Contractor assigned member ID number. After Covered California receives the 834 Effectuation File from the Contractor, Covered California shall send the Contractor a 999/TA1 Acknowledgement File confirming the Contractor’s file was received and processed. f) After Covered California has sent the monthly 820 Payment Remittance File to the Contractor, the Contractor shall send a 999/TA1 Acknowledgement File confirming the 820 File was received and processed. g) Contractor shall provide a supplemental file to dispute for those members with identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The discrepancies. Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to provide this file within two weeks of the Center for Medicaid and Medicare Services or receipt of the Center for Consumer Information and Health Insurance Oversightweekly reconciliation file. eh) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees Employers or Employees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including including, but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4100503, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS the CCSB eligibility and enrollment system that result from an applicantEmployer’s appeal of an a Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implemented. Contractor shall immediately notify Covered California if it receives an appeal decision that does not have implemented within ten (10) days of receiving all necessary data elements from Covered California required for the Contractor to implement the appeal appeals decision. In the event that a Covered California Enrollee an Employee and/or Dependent requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees Employees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in input the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the information into Contractor’s membership enrollment and financial databases. Contractor shall review and reconcile its membership enrollment and financial databases with Covered California enrollment reconciliation file on a monthly basis. The Contractor will use the Monthly Reconciliation File provided by Covered California in an EDI or CSV format to perform eligibility and financial validation and reconciliation. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide between Covered California with evidence through email confirmation that the enrollment and Contractor. The eligibility and/or financial changes identified through the Reconciliation Process have been implemented within fifteen (15) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor discrepancies shall provide written notification be reported to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s requestvia FTP. d) Contractor shall participate in the Dispute Process established ingest Standard X12 EDI benefit enrollment and maintenance set files (834) furnished by Covered California to resolve issues related and ensure Interchange acknowledgement files (999/TA1) are transmitted between Contractor and Covered California in a mutually agreed format. This includes all X12 response files (834 effectuation, TA1/999, etc.). e) Once the 834 File has been sent to the Reconciliation ProcessContractor, Covered California should receive a 999/TA1 Acknowledgement File in return from the Contractor, confirming the 834 File has been received. The Contractor shall adhere to the agreed upon turn-around time (TAT) for processing 834 Files to add a new member. Contractor shall submit send Covered California the return 834 Effectuation File which will include the member’s information and the Contractor assigned member ID number. After Covered California receives the 834 Effectuation File from the Contractor, Covered California shall send the Contractor a 999/TA1 Acknowledgement File confirming the Contractor’s file was received and processed. f) After Covered California has sent the monthly 820 Payment Remittance File to the Contractor, the Contractor shall send a 999/TA1 Acknowledgement File confirming the 820 File was received and processed. g) Contractor shall provide a supplemental file to dispute for those members with identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The discrepancies. Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to provide this file within two weeks of the Center for Medicaid and Medicare Services or receipt of the Center for Consumer Information and Health Insurance Oversightweekly reconciliation file. eh) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees Employers or Employees when Covered California notifies or confirms such change to Contractor.

Contractor Responsibilities. a) Contractor shall comply with all Federal and State eligibility and enrollment laws and regulations, including including, but not limited to, the Affordable Care Act § 1411 et seq. (42 U.S.C. § 18081 et seq.), 45 C.F.R. § 155.400 et seq., Government Code §§ 100503 and 100503.4100503, and 10 CCR § 6400 et seq. b) Contractor shall comply with all Covered California eligibility and enrollment determinations, including those made through CalHEERS and that result from an applicant’s appeal of an Covered California determination. Within ten (10) Days of receiving a request from Covered California to implement the appeals decision, Contractor shall implement appeals decisions and provide communication to Covered California with evidence the appeal resolution has been implementedimplemented within ten (10) days of receiving all necessary data elements from Covered California required to implement the appeals decision. Contractor shall immediately notify Covered California California, within three (3) days, if it receives an appeal decision that does not have all necessary data elements required for the Contractor to implement the appeal decision. In the event that a Covered California an Enrollee requires immediate care, the QHP Issuer will work closely with Covered California to implement any eligibility or enrollment changes as soon as reasonably possible. Contractor shall accept all Enrollees assigned by Covered California except as otherwise authorized by policies and procedures of Covered California or upon the approval of Covered California. c) Contractor shall participate in the Reconciliation Process to review and compare the Covered California enrollment reconciliation file, distributed monthly, against the Contractor’s membership enrollment and financial databases. Contractor shall prepare a comparison extract in accordance with the file validations and resolution timelines, as mutually agreed upon in the “Data Integrity Reconciliation Process Guide.” Contractor shall provide Covered California with evidence through email confirmation that the enrollment and financial changes identified through the Reconciliation Process have been implemented within fifteen ten (1510) business days. Further evidence of implementation is provided by individual records submitted in the next reconciliation cycle. Contractors are to follow the process as stated in the “Reconciliation Process Guide." In the event the Contractor is unable to implement the changes within fifteen (15) business days, the Contractor shall provide written notification to Covered California by the fifteenth (15th) business day. The written notification shall explain the reason why such changes cannot be implemented by the due date and shall identify another date in which the changes will be implemented. In the event Covered California identifies ongoing and persistent data issues (including L2 data errors) with the Contractor through the Reconciliation Process which have persisted for two reconciliation cycles or more and have not been resolved, the Contractor shall conduct root cause analysis, develop a corrective action plan to resolve the issues, and shall identify the implementation date of when the issues will be resolved. The Contractor’s written analysis shall be provided to Covered California within sixty (60) Days from Covered California’s request." d) Contractor shall participate in the Dispute Process established by Covered California to resolve issues related to the Reconciliation Process. Contractor shall submit a supplemental file to dispute identified discrepancies found in the Covered California enrollment reconciliation file in accordance with the defined list of fields and technical requirements established by Covered California through the “Data Integrity Reconciliation Dispute Process Guide.” The Contractor shall utilize Covered California’s Dispute Process, prior to submitting premium tax credit disputes to the Center for Medicaid and Medicare Services or the Center for Consumer Information and Health Insurance Oversight. e) Contractor shall rely upon Covered California as the system of record for eligibility and enrollment during the term of this Agreement; provided, however, that Contractor shall: : (i) reconcile premium payment information with enrollment and eligibility information received from Covered California on a monthly basis, and (ii) Contractor shall only accept changes to eligibility information submitted by Covered California Enrollees when Covered California notifies or confirms such change to Contractor.