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DEPARTMENT OF INSURANCE
Reporting

All insurer carriers offering one of the following types of programs: GAP, prompt pay, long-term care, Medicare supplement, or data are required to submit reports on quarterly or annually basis.


Reporting
Prompt Pay Supporting Data Template    - 15K
Prompt Payment Spreadsheet (03/2007)    - 27K
Prompt Pay Supporting Data Instructions    - 793K
Pharmacy Benefit Manager Annual Report Instructions    - 642K
HL-MS-1 - Refund Calculation Form    - 165K
Medicare Supplement Rate Data Sheet 2010    - 13K
Service Area Expansion Enclosure    - 9K
Provider Adequacy and Accessibility Reporting    - 91K
New Service Area Enclosure    - 9K
HIPMC-BHP1 (07/2008) - Basic Health Benefit Plan Annual Report     - 13K
Data Report Capitation Payment Sheet    - 16K
Data Report Health Benefit Plan Questionnaire    - 52K
TPA Report    - 16K
DIPR-PPR1 (07/2018) - Prompt Pay Reporting Manual    - 168K
TPA Reporting Instructions    - 17K
HIPMC-LTC 11 (09/2008) - Replacement and Lapse Reporting Form    - 11K
HIPMC-LTC 3 (09/2008) - Rescission Reporting Form    - 8K
HIPMC-LTC 4 (09/2001) - Claims Denial Reporting Form    - 60K
HIPMC-DR1 - Data Reporting Manual    - 318K
HIPMC-GAP ERF-M-1 & A-1 Monthly and Annual Report Format     - 98K
HIPMC-GAP-AFF-1 (06/01) - Guaranteed Acceptance Program (GAP) Affidavit    - 6K
HIPMC-GAP-C-1GAP (12-2000) - Guaranteed Acceptance Program (GAP) Certification Form    - 6K
HIPMC-GAPQR-2 (04/01) - Supporting Insurer's and Stop-Loss Carrier's Quarterly Report    - 6K
Geo Enclosure 1 Revision 513    - 143K
Geo Enclosure 2 Revision 114    - 10K
Limited Health Service Benefit Plan Enclosure 1    - 115K
Limited Health Service Benefit Plan Enclosure 2    - 9K
Data Reporting Template-21    - 39K
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