Call for Reports Regarding Provider Claims Processing and Related Functions

Home Bulletins 2006 Bulletins B-0018-06 April 20, 2006 To:   ALL INSURERS WRITING PREFERRED PROVIDER HEALTH BENEFIT PLANS AND ALL HEALTH MAINTENANCE ORGANIZATIONS (HMOs) Re:   Call for Reports Regarding Provider Claims Processing and Related Functions DUE: May 15, 2006 - First Quarter 2006 (January - March) Provider Claims Data 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 (TAC) §21.2821. First Quarter 2006 Provider Claims Data: The provider claims data for the reporting period January through March, 2006, is due no later than May 15, 2006 . Please use the tips listed on page 3 to review the data before you submit it. As a reminder about this data call, TDI staff will e-mail the link to the data collection application to your data contact. If you have questions about the data call or how to access the data collection application, please contact Melissa Hield via e-mail at melissa.hield@tdi.state.tx.us or call her at 512-322-4349. Sincerely, Mike Geeslin Commissioner of Insurance PDF Attachment - Tips and Instructions