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COMMISSIONER'S BULLETIN # B-0017-09

April 09, 2009


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


Re: Call for Reports Regarding Provider Claims Processing and Related Functions

Due: May 15, 2009 - First Quarter 2009 (January - March) 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.

First Quarter 2009 Provider Claims Data: The provider claims data for the reporting period January through March, 2009, is due no later than May 15, 2009 . Please use the tips beginning on page 2 to review the data before you submit it.

The online data reporting forms may be accessed on the TDI website at: https://wwwapps.tdi.state.tx.us/scpsb418/login.jsp . You can also access the data reporting forms from the TDI website: www.tdi.state.tx.us . From the TDI home page, click on More TDI Websites under Online Resources on the left side of the page. When the new page opens, click on Data Calls under the Quick Start links on the left side of the page, then scroll down to Life, Health & Licensing Data Calls and select Senate Bill 418. Your data collection contact will receive a reminder of this data call by email as well. If you have questions about the data call 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.

Tips to Assure Accurate Data Reporting



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Last updated: 09/07/2014

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