Kilpatrick

Claim Requests (HB2015)

The state of Texas requires insurers to provide detailed claim reporting upon formal request by client employers. The HB2015 reports–named after bill that created the law–are available twice every 12 months. Click here for a full text of the law.

Timing is critical. Carriers are allowed to take up to 30 days to provide the data. As long as you are able to secure the data, we recommend requesting the reports as a standard process of doing business for all of your clients. For small groups, carriers cannot underwrite health status in the fully insured market. However, the data is important for analyzing a group’s opportunity to pursue self-funded or alternative funded plan options. For large group, claim reporting is required to obtain quotes.

Aetna

Step 1 Put this template language on company letterhead, add relevant data, and sign. The employer must send it directly to the Account Manager.
Step 2 Upon receipt of the Large Claimant Report, the employer must immediately send a second formal request (see template) to receive Case Management reporting. The letter must reference the each large claimant individually.
Comments In Step 1, Aetna will send two separate secure emails—the premium vs claims before the large claimant report—to the employer. The employer must send the Step 2 request within 10 days of receipt of the Large Claimant report. The Premium vs. Claims and Large Claimant reports are Excel files.
Forms Step 1 Template
Step 2 Template
Samples Premium vs Claims Sample
Large Claimants Sample
Case Management Sample

BCBS

Step 1 Complete the BCBS HB2015 Request Form electronically, print, and have the employer sign and date. We recommend designating the broker as the recipient. Beware, if the client offers a dual/multiple option that includes an HSA qualified plan, there are two unique group numbers! Scan and email to us or the Account Manager. For tips to complete the Request Form, reference this Instruction Sheet. BCBS will respond with the Large Claimant and Pre-Certification reports in one Excel workbook.
Step 2 If BCBS does not provide a Tier I report showing monthly Premium vs Claims at renewal or with the Large Claimant report, you will need to request it specifically. Upon receipt of the Large Claimant and Pre-Cert report, send a reply email to the sender asking for the Tier I Premium vs Claims report.
Additional If the group was written in the middle market or large group segment, BCBS provides a separate detailed claim reporting package called the Blue Insight Report (see sample). This report is available online via the Producer portal or available by request of the broker is credentialed to receive it. For groups with 100+ enrolled, BCBS can provide a detailed large claimant report showing payments by diagnosis (see sample). This report can be provided by the Account Manager to brokers certified to receive it.
Comments The HB2015 Request Form must be completed in the electronic Word file. The premium vs claims is a PDF file and the Large Claimant and Pre-Cert workbook is in Excel.
Forms HB2015 Request Form
HB2015 Instructions
Samples Blue Insight Report
Sample Completed Request
Premium vs Claims Sample (Tier 1 report)
Large Claimant & Pre-Cert Sample (Tier 2)
Large Claimants by Diagnosis Report

Cigna (fully insured)

Step 1 The Broker of Record or the client can send an email to the group's Client Manager requesting a HB2015 report. The subject line heading should say HB2015 Request and include the group's name. The Account Name and Account Number should be included in the email body.
Comments Cigna will respond with all available and required reports including case management notes without requiring a followup email. Typical turnaround is 5-7 business days.
Samples Premium vs Claims Sample
Large Claimant Sample
Large Claimant Summary Sample
Membership Count Sample

Humana

Step 1 Complete the HB2015 Authorization Form and have the employer sign. Scan and email the form to us or the Account Manager.
Step 2 Put the HB2015 Request Template on company letterhead, print, complete (select all check boxes), and sign. For Dates Requesting, use a date range of a full 36 months ending on the last day of the most recent month. Employer or broker can scan and email to the Account Manager.
Step 3 Upon receipt of the Large Claimant report, the recipient must send an email response to the sender requesting Case Management data for each of the large claimants, referencing each individually in the request.
Comments The HB2015 form certifies the employer to receive the HB2015 data. In Step 2, Humana will send the requested reports via secure email. The Premium vs Claims report is in PDF and the Large Claimant and Case Management reports are in Excel.
Forms Step 1 Form
Step 2 Template
Samples Premium vs Claims Sample
Large Claimant Sample
Case Management Sample
Pre-Cert Sample
Pending Claims Sample

Memorial Hermann

Step 1 Complete the HB2015 Request Form and have the employer sign. Scan and email the form to us or the Account Manager.
Step 3 Upon receipt of the HB2015 Report, the recipient must send an email response to the sender requesting Case Management data for each of the large claimants.
Comments The Account Manager at Memorial Hermann will provide an Excel workbook (see sample) that includes the premium vs claims, large claimants, and pre-certification reports in separate sheets.
Forms HB2015 Request Form
Samples HB2015 Sample

UnitedHealthcare

Step 1 Complete the UHC HB2015 Request Form–designating the broker as the recipient–and have the employer sign and date. Scan and email to us or the Account Manager.
Step 2 Upon receipt of the Large Claimant Report, the employer must immediately send a second formal request (see template) to receive Case Management reporting. The letter must reference the each large claimant and their claim amounts individually.
Comments In Step 1, UHC will send a PDF–via secure email–to the designated recipient with three sections: pre-cert requests, monthly premium vs claims, and large claimant reporting. The Case Management reporting is in an Excel file with an OptumHealth logo.
Forms Step 1 Form
Step 2 Template
Samples HB2015 Sample
Case Management Sample

All Others

Step 1 Put the generic HB2015 request template on company letterhead, complete designating the broker as the recipient, and sign. Scan and email to us or the Account Manager.
Step 2 Upon receipt of the HB2015 reporting, the recipient must send an email response to the sender requesting Case Management data for each of the large claimants, referencing each individually in the request.
Comments This method may not work with some carriers not listed on this page. Claim request requirements should be confirmed with each carrier prior to submission.
Forms Step 1 Template