![]() Of the 230 major medical issuers in states that reported for the 2021 plan year, 162 reported receiving at least 1,000 in-network claims and show data on claims received and denied. From the public use file, we developed a working file that is posted with this brief. Our analysis excludes stand-alone dental plans and issuers with incomplete data or less than 1,000 claims submitted. This brief focuses on transparency data for the 2021 calendar year submitted by qualified health plans (QHPs) offered to individuals on as part of the 2023 plan certification process. Nor has it required any further detailed reporting (e.g., on claims or appeals by type of service or diagnosis.) Federal agencies have yet to require transparency in coverage data reporting by other non-group plans or employer-sponsored plans. 1 CMS does not collect data on all fields enumerated in the ACA, including out-of-network claims submitted and out-of-network enrollee cost sharing and payments. As a result, for any given issuer, the total plan-level claims reported may not equal the issuer-level claims reported for the 2021 coverage year. Issuers only report plan-level transparency data plans they seek to offer on in the coming year. Since 2018, issuers are also required to report data at the health plan level, including certain reasons for claims denials. In 2022, issuers reported aggregated data on all QHPs they offered in 2021. Aggregate data are reported at the issuer level. Issuers report only on the number of in-network claims submitted and denied, the number of such denials that are appealed, and the outcome of appeals. To date, reporting is required only by issuers for their qualified health plans (QHP) offered on. Partial implementation of ACA transparency data reporting began with the 2015 plan year. The law requires data to be available to state insurance regulators and to the public. Other information as determined appropriate by the Secretary. ![]()
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