28 Tex. Admin. Code § 21.5050 - Submission of Information
(a) Required
submission. A health benefit plan issuer or administrator must submit
information to the benchmarking database organization selected by the
Commissioner as required by this section.
(b) Information required. For each geozip in
Texas, a health benefit plan issuer or administrator must submit information
necessary for the benchmarking database organization to calculate a health care
or medical service or supply, as determined by the benchmarking database
organization, including:
(1) the 80th
percentile of billed charges of all physicians or health care providers who are
not facilities; and
(2) the 50th
percentile of rates paid to participating providers who are not facilities.
(c) Submission
frequency. A health benefit plan issuer or administrator must submit 2019 plan
year data by February 1, 2020, to the benchmarking database organization. After
February 1, 2020, health benefit plan issuers must submit data monthly to the
benchmarking database organization, or as required by the selected benchmarking
organization.
Notes
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