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COMMISSIONER'S BULLETIN # B-0003-07

January 24, 2007


To: ALL INSURERS WRITING PREFERRED PROVIDER HEALTH BENEFIT PLANS AND ALL HEALTH MAINTENANCE ORGANIZATIONS (HMOs)


Re: Call for Reports Regarding Provider Claims Processing and Related Functions-DUE: February 15, 2007 - Fourth Quarter 2006 (October - December) Provider Claims Data

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 §21.2821.

Fourth Quarter 2006 Provider Claims Data: The provider claims data for the reporting period October through December, 2006, is due no later than February 15, 2007 . Please use the tips listed on page 3 to review the data before you submit it.

In certain circumstances, claims will be reported in more than one quarter. Specifically, if an initial underpayment is made (and reported) and a subsequent additional payment is made in a different quarter, then the subsequent payment must be reported as a late payment as appropriate. If the subsequent payment is made outside the applicable statutory claims payment period, the carrier must reflect this in the report.

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,

[original signed by Mike Geeslin]

Mike Geeslin

Commissioner of Insurance

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Last updated: 09/16/2014

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