Section Ins 19.11 - Quarterly reporting requirements(1) Eligible health carriers shall provide the information required by this section to the commissioner within 45-days from the end of each financial quarter. The data shall be extracted from the health carrier's claims systems or similar database that tracks enrolled individual's claims.(2) Each quarterly report shall be transmitted to the commissioner, pursuant to s. 601.42, Stats., through a secure file transfer portal in a format designated by the commissioner. Instructions for submission of required information shall be provided to the eligible health carriers by the commissioner. Information in the report shall include all of the following: (a) The total number of enrolled individuals as of the last day of the applicable quarter.(b) The total amount of claims paid by the eligible health carrier in the applicable quarter.(c) A unique identifier for each enrolled individual whose claims are submitted for reinsurance.(d) For each identified enrolled individual, the total amount of eligible claims paid, consistent with s. Ins 19.07.(e) The dollar amount of paid claims eligible for reinsurance payment for each identified enrolled individual.(f) Any additional information requested by the commissioner.(3) The eligible health carrier shall use the same enrolled individual's unique identifier in each quarterly and annual report to the commissioner. For enrolled individuals with claims in more than one quarter, the amounts submitted shall reflect the cumulative dollar amount of eligible claims for that enrolled individual.(4) The eligible carrier shall report the information required by sub. (2) (a) and (b), and all applicable information for that reporting quarter even if an eligible health carrier does not have updated or eligible claims to identify.(5) All eligible health carriers who submit quarterly reports in accordance with this section shall retain a copy of the data and all supporting claims and enrollment data in an auditable format for 6 years from the last day of the applicable benefit year.(6) An authorized representative of the eligible health carrier shall complete an affirmation that the data submitted is accurate, complete, and in compliance with s. Ins 19.07. The affirmation shall be transmitted to the commissioner on the same date as the data file transfer in a format designated by the commissioner. Instructions for submission of required information shall be provided to the eligible health carriers by the commissioner.Wis. Admin. Code Office of the Commissioner of Insurance Ins 19.11
Adopted by, CR 19-088: cr. Register November 2021 No. 791, eff. 12/1/2021