4653.0200 Data Collected


Published: 2015

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$20 per month, or Get a Day Pass for only USD$4.99.
4653.0200 DATA COLLECTED.


§
A.

All health plan companies and third-party administrators must register with the data processor no later than June 15, 2009, and April 1 of each subsequent year. For the purposes of identifying data submitters, minimizing administrative burden, and assessing data completeness, all health plan companies and third-party administrators must submit the dollar amount of paid health care claims for covered individuals during the previous calendar year according to the instructions in Appendix D. The appendix is incorporated by reference in part 4653.0600.


§
B.

Data submitters are responsible for submission of the following data for each covered individual, including health care claims processed by any subcontractor on the data submitter's behalf.

§
(1)

Data submitters must submit all enrollment data elements as set forth in Appendix A. The appendix is incorporated by reference in part 4653.0600.


§
(2)

Data submitters must submit encounter data elements and pricing data for all institutional and professional health care claims paid by the data submitter under Appendix B. The appendix is incorporated by reference in part 4653.0600.


§
(3)

Data submitters must submit encounter data elements and pricing data for all pharmacy drug claims paid by the data submitter under Appendix C. The appendix is incorporated by reference in part 4653.0600.
The data processor will accept data submitted directly by a data submitter's subcontractor.