Section 21.3407 - Reporting of Required Information(a) Reporting data. A reporting entity must submit the data required by this section electronically by completing the Mandated Benefits and Mandated Offers Reporting Form found on TDI's website, www.tdi.texas.gov. A reporting entity must use medical billing codes to identify applicable claims for each mandated benefit and mandated offer of coverage.(b) Issuer's information. For each reporting year, a reporting entity must provide the following information: (1) the year for which the data is being reported;(2) the health benefit plan issuer's NAIC Number;(3) the health benefit plan issuer's name;(4) the health benefit plan issuer's mailing address;(5) the issuer type (insurance or HMO);(6) whether a third-party administrator is submitting the report;(7) the name, title, direct telephone number, email address, and mailing address of an individual who is responsible for the report;(8) whether the contact person's email address can be released;(9) the submission date; and(10) whether the health benefit plan issuer meets the reporting threshold for each reporting category (individual, small group, and large group).(c) Reporting for all covered benefits. For each reporting year, a reporting entity must provide, for all covered comprehensive health benefit plans subject to mandated benefits and mandated offers, the following aggregated data:(1) the total direct premiums earned;(2) the total dollar amount of the claims incurred; and(3) the total member months.(d) Reporting for all mandated benefits and mandated offers. For each reporting year, a reporting entity must provide the following information for each of the mandated benefits and mandated offers listed in § 21.3406 of this title (relating to Mandates for Which Data Must Be Reported), aggregated separately by individual, small group, and large group health benefit plans: (1) the total dollar amount of the claims incurred;(2) the total number of individual claims incurred; and(3) the total member months.(e) Additional reporting data. A reporting entity must provide the following information: (1) the medical billing codes used to capture the required data for the report;(2) any additional information the reporting entity believes is pertinent to the data being reported, if applicable; and(3) the certification on the data collection form.28 Tex. Admin. Code § 21.3407
The provisions of this §21.3407 adopted to be effective December 29, 2002, 27 TexReg 11990; Amended by Texas Register, Volume 42, Number 26, June 30, 2017, TexReg 3384, eff. 7/6/2017