Transparency Administration Performance Standard v1.6

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Contents

General

Purpose

Applicability

Basic Concepts

Detail

Implementation Considerations

General

Senders

Receiver

History

 

General

The UHIN Transparency Administration Performance Standard version 1.6 is compatible with state requirements set forth in Utah Code 31A-2-216(2).

Purpose

To establish performance measures that report the average telephone answer time and claim turnaround time. Information derived from the Data will be shared as public record for display on the Utah Insurance Department’s websites (insurance.utah.gov and healthrates.utah.gov).

Applicability[1]

This standard applies to all health benefit plans issued or renewed on or after January 1, 2015 or otherwise defined by Utah Administrative Insurance Rule R590-271 Data Reporting for Consumer Quality Comparison rule can be found at https://rules.utah.gov/publicat/code/r590/r590-271.htm.

Basic Concepts

Average Telephone Answer Time: The average number of seconds a customer must wait (starting at the Incoming Call Begin Point) before a representative answers an incoming telephone call.

Claim: An invoice or bill submitted to a payer for one or more medical services.

Claims Paid: Claims reported in a Remittance Advice.

Customer: Any individual, provider or member, who calls for customer service assistance.

Incoming Call Begin Point: The point in time when the final menu prompt has been selected and the caller is waiting to speak to a representative.

Measurement Periods: Annually.

Percent of Claims Paid in 15 days: The percentage of claims paid within 15 days.

Percent of Claims Paid in 30 days: The percentage of claims paid within 30 days.

SFTP: Secure File Transfer Protocol

Detail

This standard includes the following:

  • The format in which a payer will provide the data to UHIN will be in a report form. Please see the Transparency Standards Reporting Worksheet for Administrative reporting on the UHIN website: https://uhin.org/knowledge-center/#/Standards
    • Average Telephone Reporting Time
      • Total wait time divided by total customer calls (refer to customer definition)
        • Reporting Periods: Annually
      • Count of Claims Paid within 15 Calendar Days (Includes days 1 through 15)
        • Total count of claims within the reporting period that were paid within 15 days
          • This is measured from the date the claim is received to the date the claim is paid (check date)
          • Reporting Periods: Annually
        • Count of Claims Paid within 30 Calendar Days (Includes days 1 through 30)
          • Total count of claims within the Reporting period that were paid within 30 days
            • This is measured from the date the claim is received to the date the claim is paid (check date)
            • Reporting Periods: Annually
          • Total Count of Claims Paid
            • Total count claims paid within the reporting period
              • Reporting Periods: Annually

Reporting timelines and submission times:

  • Each insurer shall submit reports no later than April 1st for the preceding calendar year.

Implementation Considerations

General

  • This information will be used by the public to compare Health Insurers and Health Benefit Plans.
  • All data is reported at the company level for Utah business.
  • All data is to be sent directly to the Utah Insurance Department via the UID secure upload site. Payers are encouraged to contact UID directly for connectivity methods. Contact Jeff Hawley at healthresearch@utah.gov, or 801-538-9684.
  • A Frequently Asked Questions for Transparency Reporting document is available at https://uhin.org/knowledge-center/#/Standards.

Senders

  • Senders should contact UHIN for questions and concerns with the Standards. Contact UHIN Customer Service at 1-877-693-3071 (toll free).
  • Senders should contact the Utah Insurance Department for questions and concerns regarding reporting submission, connectivity, and acceptance. Contact Jeff Hawley at healthresearch@utah.gov, or 801-538-9684.

Receiver

  • The Utah Insurance Department is responsible for maintaining and receiving reports.

 

 

History

 

Original

V1.2

V1.3

ORIGINATION DATE

1/2010

9/16/2014

11/30/2016

APPROVAL DATE

5/18/2011

5/6/2015

12/30/2016

EFFECTIVE DATE

6/18/2011

6/6/2015

2/28/2017

 

 

V1.4

V1.5

V1.6

ORIGINATION DATE

10/16/2017

11/14/2018

11/13/2019

APPROVAL DATE

2/7/2018

1/2/2019

12/18/2019

EFFECTIVE DATE

3/7/2018

2/2/2019

1/18/2020

 

 

[1] This standard or rule may not apply to ERISA governed plans or self-insured plans as defined by the Utah Insurance Department rule, please consult with your legal department and the Utah Insurance Department for applicability.

 

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