Insurer Certification and Annual Reporting

THE SEAL OF THE STATE OF ALASKA THE STATE of ALASKA GOVERNOR BILL WALKER Department of Commerce, Community, and Economic Development DIVISION OF INSURANCE P.O. Box 110805 Juneau, AK 99811-0805 Main: 907.465.2515 Fax: 907.465.3422 # BULLETIN B 18-10 TO: HEALTH CARE INSURERS AUTHORIZED TO TRANSACT INSURANCE IN THE STATE OF ALASKA RE: INSURER CERTIFICATION AND ANNUAL REPORTING - UTILIZATION REVIEW AND BENEFIT DETERMINATIONS, GRIEVANCE PROCEDURES, AND EXTERNAL REVIEW REGULATIONS Under the authority of Alaska Statute (AS) 21.06.090 and AS 21.07.005, the director of the Division of Insurance (division) adopted regulations to modernize standards for health care insurer utilization review and benefit determinations, grievance procedures, and external reviews. These regulations became effective March 15, 2018. For a copy of the final version of the regulations, go to: https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=188809 In accordance with 3 AAC 28.916 Confidentiality Requirements, insurers are obligated to file an annual certification of compliance that the utilization review program of the insurer or the insurer's designee is in compliance with all applicable state and federal laws pertaining to confidentiality and reporting requirements. This certification shall be filed in SERFF by May 1 of each calendar year. The filing shall be signed by an appropriate official and include the following information: - Company Name, Address, Email, Telephone and Fax; - Designee (if applicable) Name, Address, Email, Telephone and Fax; - Name and title of official providing certification; and, - A statement of compliance to satisfy 3 AAC 28.916. In accordance with 3 AAC 28.932(e) Grievance reporting; recordkeeping requirements, insurers are obligated to provide an annual report and certificate of compliance related to grievance procedure requirements. This report and certification will be incorporated into the annual health survey administered by the Alaska Division of Insurance. The response date for the health survey is typically the first week in May. A bulletin will be issued at the beginning of each calendar year to provide instructions for the survey (see Bulletin 18-04 for survey announcement example). Dated this 3rd day of July, 2018, at Juneau, Alaska. Lori Wing-Heier Lori Wing-Heier Director