1. (a) Carriers and third-party administrators shall submit a member eligibility file that contains data for each member eligible for medical, dental, or pharmacy benefits for one or more dates of coverage at any time during a reporting month as well as any retrospective updates that correspond to previously submitted eligibility data. It shall include benefits, attributes, and associated effective periods.
2. (b) Carriers and third-party administrators shall include all claims adjudicated during the reporting month for all members in the member eligibility file for that month.
3. (c) Carriers’ and third-party administrators’ data submissions shall contain 180 days claims run out for members in all current or previously submitted files.

Source. #10877, eff 7-10-15; ss by #13136 eff 11-24-20