Utah Administrative Code
Topic - Insurance
Title R590 - Administration
Rule R590-262 - Health Data Authority Health Insurance Claims Reporting
Section R590-262-2 - Purpose and Scope

Universal Citation: UT Admin Code R 590-262-2

Current through Bulletin 2024-06, March 15, 2024

(1) The purpose of this rule is to:

(a) establish the requirements for entities that pay for health care to submit data to the Utah Department of Health and Human Services;

(b) coordinate with:
(i) Sections 26-1-37 and 26-33a-106.1; and

(ii) Rules R428-1 and R428-15;

(c) allow the data to be shared with the state's designated secure health information master patient index, Clinical Health Information Exchange (cHIE), to be used:
(i) in compliance with data security standards established by:
(A) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936: and

(B) the electronic commerce agreements established in a business associate agreement;

(ii) for coordination of health insurance benefits; and

(iii) for the enrollment data elements identified in Rule R428-15.

(2) This rule applies to an insurer offering or administering health insurance, including a self-funded plan that opts-in under Section R590-262-7.

(3) This rule does not apply to:

(a) an insurer that, as of the first day of the reporting period, covers fewer than 2,500 individual Utah residents;

(b) a long-term care insurance policy;

(c) an income replacement policy; or

(d) except as provided in Subsection (2)(c), a self-funded employee welfare plan.

(4)

(a) The submission of data by an insurer on behalf of a self-funded plan is considered mandatory if the self-funded employer opts-in under Section R590-262-7.

(b) An insurer is not obligated to submit data on behalf of a self-funded plan that opts-out or fails to respond to an opt-in request required in Section R590-262-7.

Disclaimer: These regulations may not be the most recent version. Utah may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.