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HMO Guidelines For Reporting Membership & Utilization

Guidelines that each HMO utilizes in reporting quarterly membership after the close of each calendar quarter and semi-annual utilization statistics.
HMO Membership Reports
HMO Utilization Reports

Consistent with 211 CMR 43.05(2) , the Division requests that each health maintenance organization (HMO) file detailed utilization information on a semi-annual basis.

The following reports summarize the utilization information as reported by each HMO
Insured Preferred Provider Membership
Individual/Small Group Membership
Non-Group Membership
Medicare Supplement Membership
Self Funded Employer Health Plan Reports
Accredited Carriers