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Managed care organization's report to the commissioner: Data, reports and information required - Conn. Gen. Stat. § 38a-478c

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Managed Care Organizations must report the following information to the Insurance Commissioner by May 1st of every year:

  • A quality assurance plan report that contains information regarding provider complaints, quality of care, patient coverage requests, and prior authorizations.  The report must contain statistical information that allows “comparison across plans.” Health Plan Employer Data Information Set (HEDIS) data must be submitted by July 1st of every year. Managed Care Organizations that do not submit HEDIS data may submit equivalent data as specified by the Commissioner.  
  • “A model contract” containing provisions used by the Managed Care Organization in their contracts with preferred provider networks.
  • “A written statement” regarding the financial arrangements between the Managed Care Organization and health care providers.
  • Information that the Commissioner needs to create the § 38a-478l consumer report cards (e.g. description of services, utilization review information).
  • A statement regarding the Managed Care Organization’s credentialing procedures.
  • “A report on claims denial data for lives covered in the state for the prior calendar year…”

Current as of June 2015