Submission of Information

(a) Required submission. A health benefit plan issuer or administrator must submit information to the benchmarking database organization selected by the Commissioner as required by this section.

(b) Information required. For each geozip in Texas, a health benefit plan issuer or administrator must submit information necessary for the benchmarking database organization to calculate a health care or medical service or supply, as determined by the benchmarking database organization, including:

(1) the 80th percentile of billed charges of all physicians or health care providers who are not facilities; and

(2) the 50th percentile of rates paid to participating providers who are not facilities.

(c) Submission frequency. A health benefit plan issuer or administrator must submit 2019 plan year data by February 1, 2020, to the benchmarking database organization. After February 1, 2020, health benefit plan issuers must submit data monthly to the benchmarking database organization, or as required by the selected benchmarking organization.

Source Note: The provisions of this §21.5050 adopted to be effective December 23, 2019, 44 TexReg 7988.