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Private Insurance Data Requirements in Michigan

Michigan laws place a wide variety of requirements on private insurers. State law requires an insurance company to have a clinical record on each patient with information on the patient such as, name, date of birth, sex, past medical history, personal history, family medical history, lab reports, drug reactions, and doctor’s notes documenting each visit.1 Insurers are also required to have a quality assurance program in place that is approved by the Department of Community Health.2 Along with having a quality assurance program, insurers are required to perform evaluations once a year in an effort to promote efficient use of resources and improving quality of care.3 State law also requires insurers to have an information security program in place that safeguards consumer information.4  Health benefit plans that provide insurance to public employers are required to provide the employers with a utilization and cost report electronically.  However, any information that the insurer releases, must be de-identified and in compliance with HIPAA regulations.5

 

Footnotes

  • 1. MI ADC R. 325.6805
  • 2. MI ADC R. 325.6601
  • 3. MI ADC R. 325.6615
  • 4. MI ADC R. 500.553
  • 5. M.C.L.A. §124.85

 

Private Insurance Data Requirements in Michigan

Subtopic Statute/Regulation Description
Health plan required reporting Mich. Admin. Code r. 325.6601 - Quality assurance program; conduct; contents Each insurer or health plan must have a quality assurance program in place that is approved by the Department of Community Health.  The quality...
Mich. Admin. Code r. 325.6801 - Clinical patient records; medical records service; record administrator or technician An insurance company is required to maintain a clinical patient record.  For treatment provided on an inpatient basis, the responsibility is on...
Mich. Admin. Code r. 325.6805 - Clinical patient records; contents; entries; organization; reports The insurance company should ensure there is a unit clinical record for each patient.  The record must include the following: 1) An...
Cost reporting by insurance companies (Cross reference Provider Resource Use) Mich. Admin. Code r. 325.6615 - Health care evaluations Each insurer or health plan must ensure that health care evaluations are done to promote the efficient use of available health resources.  The...
Mich. Admin. Code r. 325.6830 - Periodic examination of health care services; financial examinations The Department of Community Health may examine the quality of health care services being provided by an insurer or health plan.  In conducting...
Mich. Comp. Laws Ann. § 124.85 - Public employer with 100 or more employees; claims utilization and cost information; compilation; "relevant period" defined; disclosure; availability; protected health information not included; date of compilation Medical benefit plans operating within Michigan must electronically provide cost and utilization information to all public employers that have,...
Mich. Comp. Laws Ann. § 500.3508 - Quality assessment program; quality improvement program Quality assessment program; quality improvement program   All health maintenance organizations must establish a quality assessment program that...
Disclosure of information held by health plan, including notice requirements Mich. Admin. Code r. 325.6810 - Clinical patient records; confidentiality; disclosure; availability; storage and preservation Information from a patient’s clinical record in the possession of an insurance company is confidential and can only be disclosed to authorized...
Mich. Admin. Code r. 500.553 - Information security program Each insurer or health plan must implement an information security program that safeguards consumer information.  
Mich. Comp. Laws Ann. § 550.1907 - Right to request external review for adverse determination; written notice A health insurer must give an individual written notice and an explanation of internal grievance and external review processes whenever the insurer...
Privacy notices required to be given to consumers (Cross reference to Privacy & Confidentiality) Mich. Admin. Code r. 500.553 - Information security program Each insurer or health plan must implement an information security program that safeguards consumer information.  
Mich. Admin. Code r. 500.554 - Objectives of information security program The insurer or health plan’s information security program must ensure the security and confidentiality of consumer information, protect against...
Grievance procedures Mich. Admin. Code r. 500.553 - Information security program Each insurer or health plan must implement an information security program that safeguards consumer information.  
Mich. Comp. Laws Ann. § 550.1907 - Right to request external review for adverse determination; written notice A health insurer must give an individual written notice and an explanation of internal grievance and external review processes whenever the insurer...