Section 21.2425 - Claims and Utilization Review: Reporting Classifications(a) Separate reporting. Within the "MH/SUD Parity Rule Division 2 Data Collection Reporting Form" template, in the worksheet titled "Claims and Utilization Review," an issuer must separately report claims and requests for utilization review for medical/surgical and MH/SUD.(b) ICD diagnosis codes. In the worksheet titled "Claims and Utilization Review," all claims and utilization review requests with mental, behavioral, and neurodevelopmental disorder diagnosis codes in the International Classification of Diseases and Related Health Problems should be categorized as MH/SUD. Claims and utilization review requests with all other ICD diagnostic codes should be categorized as medical/surgical.(c) Reporting classifications. Claims and requests for utilization review are to be identified in the worksheet as belonging in one the following reporting classifications: (1) inpatient, in-network;(2) inpatient, out-of-network;(3) outpatient, in-network, consisting of: (4) outpatient, out-of-network, consisting of:(d) Unneeded information. Where appropriate, an issuer may enter "N/A" in the worksheet. For example, indemnity plans will not have data for in-network classifications, and HMOs with no POS component and EPOs will not have data for out-of-network classifications. An issuer of those plans may therefore enter N/A where that data is requested.28 Tex. Admin. Code § 21.2425
Adopted by Texas Register, Volume 46, Number 36, September 3, 2021, TexReg 5584, eff. 9/7/2021