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Utah Administrative Code (Current through November 1, 2019) |
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R428. Health, Center for Health Data, Health Care Statistics |
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R428-15. Health Data Authority Health Insurance Claims Reporting |
| R428-15-1. Legal Authority |
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This rule is promulgated under authority granted in Utah Code Title 26, Chapter 33a and in accordance with the Utah Health Data Plan as adopted in Rule R428-1. |
| R428-15-2. Purpose |
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This rule establishes requirements for certain entities that pay for health care to submit data to the Utah Department of Health. |
| R428-15-3. Reporting Requirements |
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(1) Each carrier shall submit health care claims data described in the Data Submission Guide for Claims Data for each covered person where Utah is the covered person's primary residence, regardless of where the services are provided. (2) Each carrier shall submit data for all fields contained in the Data Submission Guide for Claims Data if the data are available to the carrier. Each carrier shall notify the Office or its designee of any data elements that are required to be reported under this rule, but that are not available to the carrier. (3) Each carrier shall submit the health care claims data on a monthly basis. (4) Each monthly submission is due no later than the last day of the month following the month in which the carrier adjudicated the claim. |
| R428-15-4. Testing of Files |
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(1) Prior to February 14, 2014, each carrier required to report under this rule shall meet with the Office or its designee to establish a data submission testing plan and time line. Each carrier shall contact the Office to arrange this meeting by January 15, 2014. (2) Each carrier shall, according to its data submission testing plan, submit to the Office or its designee a test dataset for determining compliance with the standards for data submission and participate in testing. This test dataset must be in the same format as required by the Data Submission Guide for Claims Data as of May 15, 2014. (3) Carriers that become subject to this rule after January 15, 2014 shall submit to the Office a dataset for determining compliance with the standards for data submission no later than 90 days after the first date of becoming subject to the rule. |
| R428-15-5. Rejection of Files |
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The Office or its designee may reject and return any data submission that fails to conform to the submission requirements. A carrier whose submission is rejected shall resubmit the data in the appropriate, corrected format to the Office, or its designee within 10 state business days of notice that the data does not meet the submission requirements. |
| R428-15-6. Limitation of Liability |
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As provided in Section 26-25-1, any data supplier that submits data pursuant to this rule cannot be held liable for having provided the required information to the Department. |