DUE: November 15, 2009 - Third Quarter 2009 (July - September) 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.
Third Quarter 2009 Provider Claims Data Due: The claims data report for the reporting period July through September, 2009, is due no later than November 15, 2009.
Important: Carriers with PPO or HMO products on file with the Department that assert they are exempt from reporting this claims data must log into the Department's new system to enter a formal one-time exemption for both the HB610 and SB418 quarterly reports.
The move to the Department's new claims data reporting software application has been completed. The application that was used through the second quarter 2009 reports has been removed from service. Any links you may have previously saved will need to be replaced.
The new 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).
Before being able to submit secure data, carriers must first:
1.) email to DATAACCESS@tdi.state.tx.us a list of authorized reporters, which show the authorized reporters' email addresses along with the identification number for each company/HMO they will be reporting data for; and
2.) have their authorized reporters set up a user name and login password on the Public Account Management Site at https://apps.tdi.state.tx.us/EAU/login.do and request a user role in the new database.
Many carriers have already completed these first two steps. Carriers that have not should be aware that completing each step takes one to three days, and failure to commence the process in advance could result in untimely reporting.
In order to provide additional information on reporting in the new database and to assist carriers in the transition, 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, how to access the data collection application, or the migration process, please contact Judy Wooten via email at: promptpay@tdi.state.tx.us or call her at 512-305-7319.
Mike Geeslin
Commissioner of Insurance