NY Carriers...This absolutely involves you... Medical/Indemnity Calls all around!
To a large number of carriers in the industry, Medical and/or Indemnity Data Calls have not been a concern in the past. With participation being determined by market share, a comforting "we don't meet the threshold" has allowed many to skip over the Med Call bulletins, deadlines and requirements. But this is changing in NY.
That's right; there will be no threshold any longer. In February, the NYCIRB released bulletin R.C. 2577 detailing a plan to require all carriers, regardless of market share, to report both Indemnity Data Calls and Medical Data Calls.
Breathe. After reading that, you fell into one of four groups:
I don't know what any of this means... In this case, feel free to reach out to your stat reporting staff and refer them to this post and/or the bulletin.
We already report Med Calls to NY... Great! Keep going.
We report in other jurisdictions but not NY... NYCIRB has assumed you can turn on NY's reporting relatively easily and, as such, has given you less time to adjust. You begin reporting in June/2024 for transactions dated 1/1/2024 and later. You have roughly nine months.
We don't report anywhere... Congratulations! You have the most complete journey to complete and have been given the longest lead time. You will report for the first time in June 2025 on transactions dated 1/1/2025 and later.
If you find yourself in groups 1, 2 or 3, we'd love to help if you need it. Feel free to reach out, even if it's just for an orientation to this new reporting.
The rest of us in group 4, read on...
What is Indemnity and Medical Data Call Reporting?
On a high level, Med Data Calls are detailed transactions that your carrier pays on claims. They are generally on a line-item basis and contain Medical Procedure Codes to denote treatment and it's direct cost to the carrier.
Indemnity Data Calls are similarly detailed transactions on indemnity payments on a detailed per-payment basis. Indemnity Calls include two types of submissions: a transactional file that provides each Indemnity payment made during a quarter and a quarterly summary file on claims required to be reported.
Both are required to be reported quarterly with Med Calls having a monthly option. Testing to certify your ability to report can take considerable time, depending on your carrier's IT/Stat abilities.
What do I do?
This is a difficult question. There's no single answer; each carrier is starting at a different point with different systems and different abilities. Some of you are going to be able to fire off an email to IT, add a function to an existing team and be done. Others will need some outside tools to conquer these new challenges.
That's why we're here. LGC offers both an affordable complete outsourcing solution as well as a self-serve platform solution that integrates with your core systems (wcSYNC).
Start by scheduling a meeting at your convenience (Schedule Here). I can promise two things. One: our cost to you will be far lower than the IT initiative, opportunity costs and rework you'll inevitably run into by going-it-alone. Two: the headaches, frustrations and risk of failure you've likely already considered will become ours leaving you to focus on what really matters!