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§ 2238.12. Reporting.

10 CA ADC § 2238.12Barclays Official California Code of Regulations

Barclays California Code of Regulations
Title 10. Investment
Chapter 5. Insurance Commissioner (Refs & Annos)
Subchapter 2. Policy Forms and Other Documents
Article 5.5. Average Contracted Rate Methodology
10 CCR § 2238.12
§ 2238.12. Reporting.
Currentness
(a) For each contracting health facility, health insurers shall annually provide to the Department, with the network adequacy report submitted to the Department pursuant to Section 2240.5 of Title 10 of the California Code of Regulations, the following information:
(1) The following payment information for each service subject to Insurance Code section 10112.8:
(A) Service code;
(B) Specialty, as applicable;
(C) Number of times payment was made for that service code to non-contracting individual health professionals; and
(D) Number of times payment was made to a contracting individual health professional for that service code.
(2) The number of noncontracting individual health professionals who submitted claims for reimbursement for services provided at each contracting health facility, separated by specialty.
(3) The number of contracting individual health professionals who submitted claims for reimbursement for services provided at each contracting health facility, separated by specialty.
(b) On or before June 1, 2019, health insurers must submit via the System for Electronic Rates and Forms Filing (SERFF) of the National Association of Insurance Commissioners the policies and procedures used to determine the average contracted rates in compliance with this article. Thereafter, the policies and procedures must be submitted to the Department via SERFF whenever they are amended.

Credits

Note: Authority cited: Sections 10112.8 and 10112.82, Insurance Code. Reference: Sections 10112.8 and 10112.82, Insurance Code.
History
1. New section filed 12-26-2018; operative 1-1-2019 pursuant to Government Code section 11343.4(b)(3) (Register 2018, No. 52).
This database is current through 5/10/24 Register 2024, No. 19.
Cal. Admin. Code tit. 10, § 2238.12, 10 CA ADC § 2238.12
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