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You are here: Home . bulletins . 2013 . cc17

COMMISSIONER'S BULLETIN # B-0018-13

July 15, 2013


To: ISSUERS OF PREFERRED PROVIDER BENEFIT PLANS, HEALTH MAINTENANCE ORGANIZATION PLANS, AND SPECIFIED GOVERNMENTAL EMPLOYEE PLANS IN THE STATE OF TEXAS


Re: HEALTH CARE CLAIMS REIMBURSEMENT RATE REPORT DATA CALL

DUE: September 1, 2013 - For Reporting Period January 1, 2013 to June 30, 2013

The Texas Department of Insurance 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 the department 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.

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 September 1, 2013. The 2013 report covers data for claim payments from January 1, 2013, to June 30, 2013.

To respond to this data call, issuers must use the Microsoft Excel form LHL616, 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, you 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).

The department requests that responding issuers voluntarily comply with reporting data for updated zip codes. Newly added zip codes that are not in 28 Texas Administrative Code Chapter 21, Subchapter KK are 73960 (Panhandle), 75033 (Metroplex), 77407 (Gulf Coast), 77498 (Gulf Coast), 77523 (Gulf Coast), and 78542 (Gulf Coast). Data pertaining to these zip codes should be included in data reported for the corresponding regions.

Qualified group health benefit plan issuers 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 must 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.texas.gov.

Failure to comply with the requirements of this data call by September 1, 2013, may constitute a violation of the Insurance Code and subject the issuer to penalty.


Julia Rathgeber
Commissioner of Insurance

Link: LHL616 Data Entry Form and Instructions



For more information contact:

Last updated: 09/07/2014

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