May 04, 2021
Ohio Senate Bill 9 mandates claims data reporting
Ohio Senate Bill 9, signed into law by Governor Mike DeWine on January 7, 2021, takes effect July 1, 2021. The law requires health plan issuers to release claims data within 30 days of a formal request, once per calendar year, to groups with 50 or more full-time enrolled employees.
The law applies to fully insured group plans, self-funded non-ERISA public employee plans cities, public schools and universities.
The report provided must include all the following information for the current policy period or for the policy period immediately preceding, as requested by the group:
- Net claims paid or incurred by month
- Monthly enrollment data
- Monthly prescription claims information
- Paid claims over $30,000, including a claim identifier other than the name and the date of occurrence, the amount paid toward each claim, and claimant health condition diagnosis
An eligible group’s agent of record can request a claims report by emailing the group’s Anthem account manager beginning July 1, 2021.
Please contact your Anthem account manager for more information.