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Commissioner’s Bulletin # B-0003-18

March 07, 2018


To: Issuers of Preferred Provider Group Benefit Plans, Group Health Maintenance Organization Plans, and Specified Governmental Employee Plans in the State of Texas


Re: Health Care Claims Reimbursement Rate Report Data Call

Due:    May 1, 2018, for the January 1, 2017, to December 31, 2017, Reporting Period

The Texas Department of Insurance issues this mandatory health care claims reimbursement rate report data call in compliance with Insurance Code Chapter 38, Subchapter H. This statute requires TDI to collect data relating to 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 implementing this statute are in 28 Texas Administrative Code Chapter 21, Subchapter KK. Responding issuers should review the rules and the reporting template carefully to ensure information is reported correctly.

Applicability

This data call applies to issuers of preferred provider group benefit plans, group health maintenance organization plans, and specified governmental employee plans under Insurance Code Chapters 1551, 1575, 1579, and 1601. A health benefit plan issuer with at least 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 2017 is required to submit a report.

Submission Requirements

Respondents must complete the data call using the updated Microsoft Excel reporting template located on the Health Care Reimbursement Rate Data page on TDI's website at www.tdi.texas.gov/health/reimbursement.html.  To access the template, responding issuers must accept the "End User Agreement" concerning the use of Current Procedural Terminology (CPT) codes by clicking the button labeled "Accept." The link also includes the instructions for completing the report. Submissions are due to TDI by the close of business on Tuesday, May 1, 2018.



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Last updated: 7/16/2018