R590-271-4. Reporting Requirements

  (1)(a) The commissioner has convened a group, as identified in 31A-22-613.5(4)(a), to develop information for consumers to compare health insurers and health benefit plans. As a result of the group's work, the commissioner adopts the following UHIN electronic data interchange standards developed and adopted by the UHIN Standards Committee, which are hereby incorporated by reference with this rule and are available for public inspection at the department during normal business hours, at www.insurance.utah.gov, or at www.uhin.org:

  (i) the Transparency Administration Performance Standard, version 1.2; and

  (ii) the Transparency Denial Standards, version 1.2.

  (b)(i) Beginning on April 1, 2016, and each year thereafter, an insurer shall submit the reports referenced in R590-271-4(1)(a)

  (ii) to UHIN in an electronic data interchange standard which includes data for the previous calendar year.

  (c) Each report shall include data for both paper and electronic claims combined.

  (d) Submission format, procedures and guidelines are described in detail in the adopted transparency standards published by UHIN.

  (2) Beginning on July 1, 2016, and each year thereafter, an insurer shall comply with the reporting guidelines, procedures and format of R428-13 and submit to the Utah Department of Health Office of Health Care Statistics, the Healthcare Effectiveness Data and Information Set, HEDIS, data for the preceding calendar year.