Rules & Regulations of the State of Tennessee
Title 0780 - Commerce and Insurance
Subtitle 0780-01 - Insurance Division
Chapter 0780-01-79 - Uniform Reporting System for the All Payer Claims Database
Section 0780-01-79-.06 - COMPLIANCE WITH DATA STANDARDS AND PENALTIES FOR NON-COMPLIANCE

(a) Health insurance issuers shall make every effort to report the data fields as described in the Procedure Manual if the data field is present in any part of their data systems. Health insurance issuers shall submit data fields even in circumstances where the data is integrated from multiple systems. The Procedure Manual shall include minimum thresholds for submissions to be considered complete.

(b) The Department, or its designee, shall evaluate each member eligibility file, medical claims file and pharmacy claims file to determine compliance with the Procedure Manual.

(c) Upon completion of the evaluation, the Department or its designee shall promptly notify each health insurance issuer whether its data submissions satisfy the standards. This notification shall identify the specific file and the data elements that do not satisfy the standards.

(d) Each health insurance issuer notified of a non-compliant data submission shall respond within 10 business days of the notification by making the changes necessary to satisfy the standards.

(a) The Department may assess a civil penalty of up to one hundred dollars ($100.00) per day for delinquent claims submissions.

(b) Failure to conform to the requirements for submission shall result in the rejection of the applicable data file(s). All rejected files shall be resubmitted in the appropriate, corrected form to the Department, or their designee, within 10 business days. The Department may assess a civil penalty of up to one hundred dollars ($100.00) per day for rejected files not resubmitted within 10 business days.

(c) The Commissioner has the authority to delay, reduce, or waive any penalty for not correcting any particular data element if: