Section 230-RICR-20-30-6.7 - Reporting RequirementsA. A subject entity that does not have a finding of substantial compliance from the OHIC in effect shall submit a report to the OHIC based on the following guidelines: 1. a subject entity that processed, on average, fewer than 10,000 claims per month during the previous calendar year shall, no later than January 31st of the following calendar year, submit a report to the OHIC in the form promulgated by OHIC in a Bulletin issued for that purpose; and2. a subject entity that processed, on average, 10,000 or more claims per month during the previous calendar year shall, within thirty days following the end of each month, submit a report to the OHIC in the form promulgated by OHIC in a Bulletin issued for that purpose.B. A subject entity that operates multiple plans in Rhode Island shall aggregate the claims processing data for all of its plans when submitting the report or reports required by § 6.7(A) of this Part.C. Subject entities that are related, but are separate legal entities (e.g., parent and subsidiary corporations, two corporations with the same parent, etc.), or are otherwise affiliates, shall file separate reports when submitting the report or reports required by § 6.7(A) of this Part.D. The report or reports required by § 6.7(A) of this Part shall include information related to claims for payment processed on behalf of or for the subject entity by an agent, contractor, subsidiary or any other entity, regardless of whether such claims are: 1. forwarded to the agent, contractor, subsidiary or other entity for processing by the subject entity; or2. submitted directly to the agent, contractor, subsidiary or other entity for processing by a health care provider or policyholder.E. Examples 1. Example 1. A subject entity operates a single health plan in Rhode Island. The subject entity processed, on average, 9,500 claims per month during 2006. Because the subject entity processed, on average, fewer than 10,000 claims per month during 2006, the subject entity is not required to submit a monthly prompt processing report during 2007. Instead, the subject entity must file a single annual report no later than January 31, 2008.2. Example 2. A subject entity operates a single health plan in Rhode Island. That subject entity processed, on average, 10,500 claims per month during 2006. Because the subject entity processed, on average, 10,000 or more claims per month during 2006, the subject entity is required to submit a monthly prompt processing report during 2007. The subject entity must submit each such report within thirty days following the end of each month in 2007.3. Example 3. A subject entity operates several health plans in Rhode Island. The subject entity processed, on average, a total of 9,500 claims per month during 2006 for all of its plans. Because the subject entity processed, on average, fewer than 10,000 claims per month during 2006, the subject entity is not required to submit a monthly prompt processing report during 2007. Instead, the subject entity must file a single annual report covering all of its plans no later than January 31, 2008.4. Example 4. A subject entity operates several health plans in Rhode Island. The subject entity processed, on average, a total of 10,500 claims per month during 2006 for all of its plans. Because the subject entity processed, on average, 10,000 or more claims per month during 2006, the subject entity is required to submit a single monthly prompt processing report covering all of its plans during 2007. The subject entity must submit each such report within thirty days following the end of each month in 2007.5. Example 5. Company A and Company B are two separate, but related subject entities. Company A and Company B each operate several health plans in Rhode Island. Company A processed, on average, 9,500 claims per month during 2006. Company B processed, on average, 10,500 claims per month during 2006. Because Company A processed, on average, fewer than 10,000 claims per month during 2005, Company A is not required to submit a monthly prompt processing report during 2007. Because Company B processed, on average, more than 10,000 claims per month during 2006, Company B is required to submit a single monthly prompt processing report covering all of its plans during 2007. Because each of these companies must file separate reports, Company A must file a single annual report no later than January 31, 2008 and Company B must submit each monthly report within thirty days following the end of each month in 2007.6. Example 6. An out of state entity processes mental health claims on behalf of or for a subject entity operating in Rhode Island. Health care providers and policyholders submit mental health claims directly to the out of state entity, not the subject entity. These claims must be included in the subject entity's report required by § 6.7(A) of this Part.7. Example 7. A subject entity operates several health plans in Rhode Island. The subject entity has contracted with another entity to process all of its claims. Regardless of whether the claims are submitted directly to the subject entity or the contractor, the subject entity must include these claims in its report required by § 6.7(A) of this Part. Under such circumstances, the contractor should not submit a separate report.F. The report should be submitted to the address specified in § 6.8 of this Part. The OHIC considers reports submitted pursuant to § 6.7 of this Part to be public records under R.I. Gen. Laws § 38-2-1 et seq., but only to the extent that a subject entity does not include personal, identifiable health information in the report.230 R.I. Code R. 230-RICR-20-30-6.7