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HMO Reporting Requirements

Health Maintenance Organizations (HMOs) are required to report certain information to TDI on a quarterly, biannual, or annual basis. Some of the information HMOs are required to report includes, information regarding complaints, financial solvency, clean claim processing and utilization review.

Disclaimer

The following information has been provided as a courtesy and is not inclusive of all and/or other instances where entities may be required to report to TDI. The following does not exempt an entity from complying with all applicable requirements in the Texas Insurance Code and Texas Administrative Code.

Provider Ombudsman

The role of the provider ombudsman is to assist health care providers in their dealings with health benefit plans. The provider ombudsman expedites resolution of provider complaints and analyzes complaint data for patterns or violations that require corrective action. The provider ombudsman may suggest changes in Texas Department of Insurance rules if necessary to improve compliance with insurance laws. Katrina Daniel, Associate Commissioner of the Life, Accident, & Health Section, is the health care provider ombudsman for the Texas Department of Insurance.

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Last updated: 09/06/2014

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