11 NCAC 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).

(d)  Schedule H, Section II ‑ Analysis of Unpaid Claims, updated as of the current valuation date.

(e)  All data in this Rule shall be recorded on a 3.5" diskette containing a LOTUS worksheet named CLM_RES.WK3 or CLM_RES.WK1; which can be obtained from the Actuarial Services Division.

(f)  A hard copy of the LOTUS worksheet shall accompany the filing.

 

History Note:        Authority G.S. 58‑2‑40; 58‑67‑135(b); 58‑67‑150;

Eff. February 1, 1995;

Amended Eff. December 1, 1995.