Due: May 1, 2017 – for Reporting Period January 1, 2016, to December 31, 2016
The Texas Department of Insurance (TDI) issues this mandatory health care claims reimbursement rate report data call in compliance with Texas Insurance Code Chapter 38, Subchapter H. This section of the statute requires TDI to collect data concerning health benefit plan reimbursement rates in a uniform format and to disseminate the combined rates derived from this data by geographical regions in the state. The rules that implement this statute are in 28 Texas Administrative Code Chapter 21, Subchapter KK. Responding issuers should review the rules and reporting form carefully to ensure that information is reported correctly.
This data call applies to issuers of preferred provider benefit plans, health maintenance organization plans, and specified governmental employee plans under Insurance Code Chapters 1551, 1575, 1579, and 1601. Issuers must submit this data by May 1, 2017. The 2016 report covers data for claim payments from January 1, 2016, to December 31, 2016.
To respond to this data call, issuers must use the Microsoft Excel reporting form, accessible via the link at the end of this bulletin, and submit the completed form electronically to ReimbursementRates@tdi.texas.gov. To access the reporting form, responding issuers must accept the "End User Agreement" concerning use of current procedural terminology by clicking the button labeled "Accept."
As prescribed by 28 TAC §21.4502(e), a health benefit plan issuer with fewer than 20,000 covered lives in comprehensive health coverage as reported on Part 1 of the National Association of Insurance Commissioners Supplemental Health Care Exhibit as of the end of 2016 is not required to submit a report. If you are unable to download the form, or have any questions concerning this data call, please contact TDI at ReimbursementRates@tdi.texas.gov.