DUE: February 15, 2010 - Fourth Quarter 2009 (October - December) Provider Claims Data Report
Pursuant to §38.001 of the Texas Insurance Code (TIC), the Texas Department of Insurance (Department) issues this mandatory data call for insurers with preferred provider health benefit plans (PPOs) filed in Texas, and for health maintenance organizations (HMOs) doing business in Texas (collectively, hereafter, "carriers").
This data call is necessary for the Department to determine carriers' compliance with various "prompt pay" requirements relating to claims submitted by providers, as addressed under TIC Ch. 1301 and Ch. 843, Subchapter J and rules adopted to implement those statutes. Carriers' complete responses to this data call are also necessary for compliance with 28 Texas Administrative Code §21.2821.
Fourth Quarter 2009 Provider Claims Data: The claims data report for the reporting period October through December 2009, is due no later than February 15, 2010.
The online claims data reporting application and forms may be accessed on the Department's website at: https://apps.tdi.state.tx.us/SB418company/Login.do. In the event the link fails to work, you may also access the data reporting application and forms from the Department's home page at: www.tdi.state.tx.us. From there, click on Popular Links under the Quick Start links on the left side of the page. When the new page opens, click on Data Calls under the Quick Start links, then scroll down to Life, Health & Licensing Data Calls and select Claims Data Reporting (HB610/SB418).
In order to provide additional information on reporting, the Department has created a webpage with detailed additional information here: www.tdi.state.tx.us/health/documents/provclaimstips.doc.
If you have questions about the data calls or how to access the data collection application, please contact Judy Wooten via email at: promptpay@tdi.state.tx.us or call her at 512-305-7319.
Mike Geeslin
Commissioner of Insurance