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 2008 Provider Claims Data: The provider claims data for the reporting period January through March, 2008, is due no later than May 15, 2008. Please be advised that failure to report by the deadline may result in regulatory action, including enforcement. 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.
The online data reporting forms may be accessed on the TDI website at: http://www.tdi.state.tx.us/webinfo/datacall.html. You can still access the data reporting forms from the TDI website: www.tdi.state.tx.us. From the TDI home page, click on Surveys under Section Links on the right side of the page. Then scroll down to Life Health 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 Katrina Daniel via email at: promptpay@tdi.state.tx.us or call her at 512-322-4315.
Mike Geeslin
Commissioner of Insurance
Tips for Reporting Pharmacy Claims Data; Assure Accurate Data Reporting; HB 610 Quarterly Data Collection Form, Quarterly Report Instructions; SB 418 Quarterly Report Instructions; Provider Claims Data Call