1095 RESPONSIBILITY MATRIX
Year / employer:
Plan | Funding | Effective period | Responsible reporting entity
Deliverable | Performing organization | Employer approver | Due date | Evidence
Carrier confirmation received:
Outgoing provider historical data:
Incoming provider overlap review:
Self-insured covered-person source:
Filing batch / acknowledgment owner:
Furnishing and employee inquiry owner:
Correction support after transition:
Unresolved gaps / escalation contact:
Final employer approval: