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054.00.100-5. General Reporting Requirements; Exemptions.

AR ADC 054.00.100-5Arkansas Administrative CodeEffective: November 2, 2015

West's Arkansas Administrative Code
Title 054. Insurance Department
Division 00.
Rule 100. Arkansas Healthcare Transparency Initiative Standards
Effective: November 2, 2015
Ark. Admin. Code 054.00.100-5
054.00.100-5. General Reporting Requirements; Exemptions.
Currentness
A. Submitting Entity Requirements. Unless exempted by the Commissioner in accordance with Section 5.C of this Rule or by the explicit language of this Rule, a submitting entity shall submit to the Arkansas Insurance Department through the Administrator a completed data set for an enrollment file, a medical claims file, a dental claims file, a pharmacy claims file, a provider file, and a validation report in accordance with Section 5 of this Rule and with the requirements outlined in the Data Submission Guide.
B. Data Submission Timing. Submitting entities shall provide data in accordance with the following schedule:
1. Test files for submitting entities must be submitted no later than January 1, 2016.
2. Historical data and regular quarterly submission will commence following submission of test files according to the submission schedule in Appendix A. For purposes of the submission schedule the following groupings apply:
a. Group 1 means submitting entities listed in the Definition Section 4(21)a.i. with at least 100,000 covered individuals as of December 31, 2015 and entities listed in the Definition Section 4(21)a.ii., iii., iv., and vi.;
b. Group 2 means submitting entities listed in Definition Section 4(21)a.i. with at least 25,000 covered individuals but fewer than 100,000 covered individuals as of December 31, 2015;
c. Group 3 means submitting entities listed in Definition Section 4(21)a.i. with at least 10,000 covered individuals but fewer than 25,000 covered individuals as of December 31, 2015;
d. Group 4 means submitting entities listed in Definition Section 4(21)a.v. and submitting entities listed in Definition Section 4(21)a.i. with at least 2,000 covered individuals but fewer than 10,000 covered individuals as of December 31, 2015.
3. Unless otherwise exempted under Section 5.C of this Rule, submitting entities must submit data according to the established patterns identified in the submission schedule in Appendix A for future years not explicitly listed in the schedule.
4. Entities qualifying in more than one Group listed in Section 5.B.2 must submit claims for all covered individuals according to the schedule listed for the first Group in which the entity qualifies.
C. Submitting Entity Exemptions. An entity with fewer than two thousand (2,000) covered individuals as of December 31 of the previous calendar year will not be required to submit data in accordance with this Rule. For purposes of determining whether an entity is subject to the requirements of this rule and for data submission timing in Section 5.B of this Rule, entities must aggregate the number of covered individuals for all companies at the Group Code level as defined by the National Association of Insurance Commissioners. Entities that offer medical, dental, and pharmaceutical benefits, or any combination thereof, under separate or combined plans will count all covered individuals, irrespective of the comprehensiveness of the plan, toward the two thousand (2,000) covered individual threshold.
The Arkansas Workers' Compensation Commission is exempt from submitting a provider file as required by this Section. Until further notice, employer self-funded health plans are exempt from all requirements in this Rule.
The Commissioner may, for good cause, grant an exemption to a submitting entity (or to a class of which the entity is a member) for all or some of the requirements of this Rule. “Good cause” includes without limitation pending litigation which may preempt application of the Act to a submitting entity. The Commissioner will respond in writing within 30 days to any exemption request.
If an entity does not believe it meets the definition of a submitting entity herein or does not believe it meets the 2,000 covered individuals threshold, that entity may dispute the Commissioner's decision in accordance with the administrative procedures of the State of Arkansas.

Credits

Adopted Nov. 2, 2015.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.100-5, AR ADC 054.00.100-5
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