DUE: September 1, 2012 - Reporting Period January 1, 2012, to June 30, 2012
In order to comply with Texas Insurance Code Chapter 38, Subchapter H, the Texas Department of Insurance issues this mandatory Health Care Claims Reimbursement Rate Report data call. This statute requires TDI to collect data concerning health benefit plan reimbursement rates in a uniform format, and to combine this information and make it available by geographical region in Texas. TDI adopted rules to implement this statute in 28 Texas Administrative Code Chapter 21, Subchapter KK.
The Health Care Claims Reimbursement Rate Report applies to issuers of preferred provider benefit plans, health maintenance organization plans, and specified governmental employee plans under TIC Chapters 1551, 1575, 1579, and 1601. Issuers are required to submit this data by September 1, 2012. The 2012 report covers data for claim payments from January 1, 2012, to June 30, 2012.
Data must be submitted electronically to ReimbursementRates@tdi.state.tx.us using Microsoft Excel form LHL616, accessible through the link at the bottom of this bulletin. To access the reporting form, the user must accept the End User Agreement concerning use of Current Procedural Terminology by clicking the button labeled "Accept." The content of the End User Agreement is provided in 28 TAC §21.4506(f).
A group health benefit plan issuer may submit to the department an exemption statement and the data required in Section B of form LHL616 to support an exemption in place of the full report. As prescribed by 28 TAC §21.4506(e), a group health benefit plan issuer asserting an exemption shall certify that the group health benefit plan issuer is exempt from the reporting requirement applicable to its health benefit plans for one of the following reasons:
(1) the total number of all covered lives in private market preferred provider benefit plans operating under the Insurance Code Chapter 1301 and offered by the health benefit plan issuer in Texas does not exceed 10,000 persons as of December 31 of the year preceding the report; or
(2) the total number of all covered lives in the private market health maintenance organization plans operating under the Insurance Code Chapter 843 and offered by the health benefit plan issuer does not exceed 10,000 persons as of December 31 of the year preceding the report.
If you are unable to download the form, or have any questions concerning this data call, please contact TDI via email at ReimbursementRates@tdi.state.tx.us.
Failure to comply with the requirements of this data call by September 1, 2012, may constitute a violation of the TIC and may subject the insurer to penalty.
Eleanor Kitzman
Commissioner of Insurance