11 N.C. Admin. Code 16.0704

Current through Register Vol. 39, No. 12, December 1, 2024

Section 16 .0704 - CLAIM RESERVE DATA AND FORMAT REQUIREMENTS

(a) The data requirements in Paragraph (b) of this Rule shall be recorded for the following types of claims:

(1) inpatient Claims;

(2) physician Claims;

(3) referral Claims; and

(4) other.

(b) For the most recent 24-month period immediately preceding and including the valuation date, the following "monthly" historical data shall be recorded by the month in which the claim or payment was incurred and by the following:

(1) cumulative number of claims reported through the 24-month period;

(2) cumulative number of claims paid through the 24-month period;

(3) cumulative dollar amount of claims paid through the 24-month period; and

(4) cumulative dollar amount of claims incurred through the 24-month period.

(c) The following monthly historical data shall be recorded for the most recent 24-month period immediately preceding and including the valuation date:

(1) earned premiums by calendar month;

(2) total number of enrollees at the beginning and end of each month; and

(3) data on claim amounts greater than or equal to one hundred thousand dollars ($100,000).

11 N.C. Admin. Code 16 .0704

Authority G.S. 58-2-40; 58-67-135(b); 58-67-150;
Eff. February 1, 1995;
Amended Eff. December 1, 1995;
Readopted Eff. October 1, 2018.

Authority G.S. 58-2-40; 58-67-135(b); 58-67-150;
Eff. February 1, 1995;
Amended Eff. December 1, 1995.

Readopted by North Carolina Register Volume 33, Issue 09, November 1, 2018 effective 10/1/2018.