DUE: May 15, 2010 - First Quarter 2010 (January - March) 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.
First Quarter 2010 Provider Claims Data: The claims data report for the reporting period January through March 2010, is due no later than May 15, 2010.
The Department would also like to remind carriers that there are two reports due with this data call.
The HB610 report is to be used to report provider claims paid under contracts that were last issued or renewed before August 16, 2003. TDI understands that many carriers may no longer have claims that fall into this category so those carriers will not use this form. If you do not have these older provider contracts, you are encouraged to enter the one-time exemption for the HB610 report. Entering a one-time exemption for the HB610 report will not block your ability to enter data for the SB418 report.
The SB418 report is to be used to report provider claims paid under contracts that were last issued or renewed on or after August 16, 2003. If a carrier has no provider claims that fall under this category, a one-time exemption form (separate from the HB610 exemption) will need to be completed.
Once a carrier has submitted an exemption form for a report, the carrier no longer needs to respond to the data call for that particular report. If only one exemption form has been submitted, the carrier is still required to respond to the other report on a quarterly basis.
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