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§ 422.2480 MLR review and non-compliance.
To ensure the accuracy of MLR reporting, CMS conducts selected review of data submitted under § 422.2460 to determine that that the MLRs and remittance amounts under § 422.2410(b) and sanctions under § 422.2410(c) and (d), were accurately calculated, reported, and applied.
(a) The reviews include a validation of amounts included in both the numerator and denominator of the MLR calculation reported to CMS.