Health Maintence Organization (HMO) Data Reporting Requirements

Who needs to report

Commercial Product Basic Service HMOs (PDF, 264 KB) are required to report Texas’ subset of HEDIS^® 2013 (2012 data) by service area. The requirement for reporting is based on enrollment numbers as of December 31, 2011.

What measures to report

THCIC expects the Texas Subset of HEDIS® 2013 (PDF, 31 KB) to be reported for the 2012 data year.

When, where and how to report

• Commercial
  

  THCIC is currently receiving offers for the contracted service of the HEDIS^® collection for the state and the submission guidelines have not yet been determined, therefore the 2013 HEDIS® Data Submission Timeline is not yet available. This will posted as soon as possible.

  On or before June 17 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:

Bruce M. Burns, D.C.
Team Lead, Program Specialist
Texas Health Care Information Collection
DSHS - Center for Health Statistics, Mail Code -1898
PO Box 149347
Austin, TX 78714-9909
Phone: 512-776-7261
Fax: 512-776-7740

• Medicaid
  THCIC will not collect any data from Medicaid HMOs for HEDIS^® 2013.
• CHIP
  THCIC will not collect any data from CHIP HMOs for HEDIS^®2013.
• Medicare
  THCIC will not collect any data from Medicare HMOs for HEDIS^® 2013.

Exemption from HEDIS® Reporting

• Criteria (PDF, 70 KB) for consideration of exemption from reporting

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