Health Maintence Organization (HMO) Data Reporting Requirements

Who needs to report

Commercial Product Basic Service HMOs (PDF, 64 KB) are required to report Texas’ subset of HEDIS^® 2012 (2011 data) by service area. The requirement for reporting is based on enrollment numbers as of December 31, 2010.

What measures to report

THCIC expects the Texas Subset of HEDIS® 2012 (PDF, 24 KB) to be reported for the 2011 data year.

When, where and how to report

• Commercial
  

  THCIC has contracted with NCQA to collect Texas' subset of HEDIS^® on its behalf. THCIC deadlines mirror those of NCQA. The 2009 HEDIS^® Data Submission Timeline is not yet available on NCQA's website.

  On or before June 15 HMOs must also provide copies of the completed NCQA Interactive Data Submission System (IDSS), the Audit Designation Table and the Final Audit Statement directly to THCIC. Electronic copies are preferred. Paper copies can be mailed to:

Texas Department of State Health Services
Center for Health Statistics
Texas Health Care Information Collection, MC-1898
PO Box 149347
Austin, TX 78714
Phone: 512-458-7261
Fax: 512-458-7740

• Medicaid
  THCIC will not collect any data from Medicaid HMOs for HEDIS^® 2012.
• CHIP
  THCIC will not collect any data from CHIP HMOs for HEDIS^®2012.
• Medicare
  THCIC will not collect any data from Medicare HMOs for HEDIS^® 2012.

Exemption from HEDIS® Reporting

• Criteria (PDF, 22 KB) for consideration of exemption from reporting

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