Insurers that offer plans on Healthcare.gov could risk losing out on payments if they fail to properly submit policy reports via a new, automated intake system, warns a notice from the Centers for Medicare & Medicaid Services.
"Issuers that are not deemed ready for implementation in January 2016 will be paid under a partial payment withholding schedule based on the issuer's manual payment process submissions," the notice says.
But once an issuer successfully implements the automated "policy-based payment" process, it "will have each month's partial payment adjusted to reflect the full policy-based payment calculation for that month," according to CMS. Notice