Electronic Semi-Annual Claims Data Filing

BULLETIN 09-01 Date: January 30, 2009 To: Third-Party Payors, including Health Insurers, Nonprofit Health Service Plans, Health Maintenance Organizations, Managed Care Organizations, and Third-Party Administrators Re: Electronic Semi-Annual Claims Data Filing **************************************************************************** COMAR 31.10.11.14 requires that twice each calendar year a third-party payor submit to the Insurance Commissioner a claims data filing. A third-party payor is defined by COMAR 31.10.11.02 as a person that administers or provides reimbursement for health care benefits on an expense-incurred basis. A third-party payor includes, but is not limited to, a health maintenance organization, a health insurer, a nonprofit health service plan, a third party administrator and a managed care organization. The claims data filing is due September 1 for claims received for the period January 1 to June 30 of the same calendar year and March 1 for claims received for the period July 1 to December 31 of the preceding year. To facilitate claims data filing by third-party payors, the Maryland Insurance Administration (MIA) developed an electronic form as an alternative to the paper form previously used. Beginning with the March 1, 2009 claims data filing required by COMAR 31.10.11.14, it is the Insurance Commissioner’s preference that third-party payors complete the claims data filing electronically. The Insurance Commissioner intends to promulgate regulations for mandatory use of the electronic form for future claims data filings. To complete a claims data filing electronically, a third-party payor must have designated a single contact for the March 1, 2009 claims data filing no later than close of business on February 16, 2009 and least 30 days prior to the applicable date for the semi-annual claims data filing submission thereafter. The designated single contact may be an employee of the thirdparty payor or may be an employee of a delegated agent processing claims on behalf of the third- RALPH S. TYLER Commissioner BETH SAMMIS Deputy Commissioner MARTIN O’MALLEY Governor ANTHONY G. BROWN Lt. Governor STATE OF MARYLAND MARYLAND INSURANCE ADMINISTRATION 525 St. Paul Place, Baltimore, Maryland 21202-2272 party payor. A third-party payor may designate the single contact by contacting the MIA at mc_filings@mdinsurance.state.md.us (note: underscore between “mc” and “filings”). The MIA will forward an identification code, a password and the Internet address for submitting the claims data filing electronically to the designated single contact. It is the responsibility of the third-party payor to ensure the designated single contact is current and accurate for the March 1, 2009 claims data filing and for each subsequent claims data filing. If there is a change in the previously designated single contact for a third-party payor that completed the required claims data filing electronically, the third-party payor must contact the MIA at mc_filings@mdinsurance.state.md.us (note: underscore between “mc” and “filings”). The MIA will disable the identification code and password for the previously designated single contact and issue a new identification code and password to the newly designated single contact along with the Internet address for submitting the claims data filing electronically. Instructions for electronic filing and a sample copy of the form are on the MIA’s website at http://www.mdinsurance.state.md.us/sa/documents/Semi-AnnualClaimDataFilingInstructions2007- web.pdf. The paper form may be found on the MIA’s website at http://www.mdinsurance.state.md.us/sa/documents/CleanClaimFilingForm.pdf The Insurance Commissioner may impose penalties in accordance with COMAR 31.10.11.14 if a third-party payor submits inaccurate information and/or in accordance with §4-113 of the Insurance Article, if the third-party payor does not submit the claims data filing by the specified deadline. Questions about this filing may be directed to Thomas Marshall, Coordinator Compliance and Enforcement, by phone at 410-468-2217, or by e-mail at tmarshall@mdinsurance.state.md.us . By: _Signature on Original_______ Beth Sammis Deputy Commissioner Maryland Insurance Administration