DUE: August 15, 2006 - Second Quarter 2006 (April - June) Provider Claims Data and Annual Report of Reasons for Declinations
Pursuant to §38.001 of the Texas Insurance Code (TIC), the Texas Department of Insurance (TDI) issues the attached mandatory data call for insurers writing preferred provider health benefit plans in Texas, and for health maintenance organizations doing business in Texas (collectively, hereafter, "carriers"). This data call is necessary for TDI 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 (TAC) §21.2821.
Second Quarter 2006 Provider Claims Data: The provider claims data for the reporting period April through June, 2006, is due no later than August 15, 2006 . Please use the tips listed on page 3 to review the data before you submit it.
SB 418 Annual Report of Declination Data: Carriers are required to report annually the reasons for declining to verify a claim, referred to as declinations. Carriers should report declination data from July 1, 2005, through June 30, 2006. Also, carriers must submit reports about declinations issued by each delegated entity that processes that carrier's insured and/or enrollees' claims. Carriers and their delegated entities, if applicable, must retain the data used to calculate the totals reported to TDI for a minimum of three years, and the data must be available for review by TDI. The annual report of declination data is due no later than August 15, 2006. The reporting date was amended by rule to coincide with the second quarter reporting date. To view the rule on TDI's website, please click on http://www.tdi.state.tx.us/rules/2005/1229E-059.html.
As a reminder about this data call, TDI staff will e-mail the link to the data collection application to your data contact. If you have questions about the data call or how to access the data collection application, please contact Melissa Hield via e-mail at melissa.hield@tdi.state.tx.us or call her at 512-322-4349.
Sincerely,
Mike Geeslin
Commissioner of Insurance