205.623 Information on claims paid for insurance policyholders and dependents --

263 words·~1 min read·/ky/205-623

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Use of data -- Confidentiality of information -- Prohibited fees.

(1)All health insurers and administrators as defined under KRS Chapter 304 shall

provide upon request to the Department for Medicaid Services, by electronic means

and in the format prescribed by the department, policy and coverage information

and claims paid data on Medicaid-eligible policyholders and dependents. Any

request from the department shall include a list of data elements that shall be

included on the electronic file from the insurer or administrator.

(2)All health insurers and administrators as defined under KRS Chapter 304 shall

provide upon request to the department, by electronic means and in the format

prescribed by the department, identifying information on all policyholders and

dependents to match with the Medicaid management information system to

determine which policyholders and dependents also participate in the Kentucky

Medical Assistance Program. The identifying information shall include the name,

address, date of birth, and Social Security number as these items appear in the

companies' files and as the department may require.

(3)No health insurer or administrator shall be required to provide information under

this section if doing so would violate any provision of federal law.

(4)All information obtained by the department pursuant to this section shall be

confidential and shall not be open for public inspection.

(5)The department shall not be charged a fee by a third party for information requested

under this section, nor shall the department be charged a fee by a third party for the

processing and adjudication of the department's claim for recovery, reclamation, or

validation of eligibility.