Data Filing and Penalties

(1) Filing Periods. The filing period for each claims data file listed shall be determined by the total number of covered lives who are Massachusettsresidentsforwhomclaims are being paid or processed by each carrier or health claims processor. For those carriers having 2,000 or more Massachusetts covered lives, data shall be submitted monthly. For those carriers or health care claims processors having fewer than 2,000 Massachusetts covered lives, data shall be submitted quarterly. (2) Testing of Files. At least 30 days prior to the initial submission of the files, each carrier shall submit to the Council, or its designee, a data set for determining compliance with the standards for data submission. The size, based upona calendarperiod of one month, or quarter of the data files submitted shall correspond to the filing period established for that carrier. (3) Rejection of Files. Failure to conform to the requirements for submission shall result in the rejection and return of the applicable data file(s). All rejected and returned files shall be resubmitted in the appropriate, corrected form to the Council, or its designee, within ten days. (4) Replacement of Data Files. No carrier shall replace a complete data file submission more than one year after the end of the month in which the file was submitted unless it can establish exceptional circumstances for the replacement. Any replacements after this period shall be approved by the Council. Individual adjustment records shall be submitted with a monthly data file submission. (5) Penalties. If any carrier fails to submit required data to the council on a timely basis, or fails to correct submissions rejected because of excessive errors, the council or its designee shall provide written notice to the carrier or health care claims processor. Pursuant to M.G.L. c. 6A, § 16L(d), if the carrier or health care claims processor fails, without just cause, to provide the required information within two weeks following receipt of said written notice, the Council may require the carrier to pay a penaltyof$1,000 for each week of delay; provided, however, that the maximumpenaltyunder 129 CMR 2.07 shall be $50,000 per year. The Statistical Plan developed pursuant to 129 CMR2.08shall include the standards the Council or its designee will use to assess penalties for failure to submit required data, and shall define “just cause” for delays in providing required data.