ATTENTION REQUIRED: EMPLOYER ACTION MAY BE NECESSARY
Under the Consolidated Appropriations Act (CAA), health insurers offering group or individual health coverage and self-funded group health plans are required to report data annually regarding prescription drugs and healthcare spending to the Departments of Health and Human Services, Labor, and Treasury (Tri-Agencies).
The next required submission date to report 2022 data is June 1, 2023. This information must be submitted through a web portal set up by the Centers for Medicare & Medicaid Services (CMS).
Please refer to the information below that applies to your 2022 health benefit plan arrangement / carrier for further information / reminder on next actions on your part.
Fully Insured Employer Groups:
Anthem (includes KCIT groups): Anthem will be submitting the files for all fully insured customers who had active coverage during the 2022 reference year. Anthem previously sent out an email to fully insured customers (linked below) to gather needed information to complete their data for the upcoming filing. Employers MUST submit the requested data to Anthem by the due date of March 1, 2023 so that the filing can be complete. If any questions, contact your Account Executive / Manager.
UnitedHealthcare (UHC): UHC will be submitting the files for all fully insured and level-funded customers who had active coverage during the 2022 reference year. UHC sent a survey to all fully insured and level-funded customers (linked below) to gather needed information to complete their data for the upcoming filing. Please submit the requested data to UHC by the due date of March 3, 2023, so that your filing can be complete.
UHC Instructions | UHC Survey Link
Humana: We are still awaiting confirmation from Humana but expect that they will also be handling the filing requirements for fully insured customers and will be requesting needed data from customers to complete their filing. We will provide this information to our Humana employer groups as it becomes available.
Self-Funded Employer Groups:
The approach for self-funded employer groups varies. We have summarized below what we know currently regarding the carrier approaches for self-funded customers.
Anthem – Updated as of 2/20/2022:
Anthem will be submitting the files for ASO (self-funded) customers. Update: For the 2022 reporting year (due to CMS by June 1, 2023), ASO groups will now have the option to request that Anthem file the Data Sheet (D1) reports on their behalf provided that the request and required information is received by March 24, 2023. Anthem is sending an email to ASO customers with more information and what is needed by March 24, 2023 for them to complete the filing. Your Bim Group Account Executive will also reach out to our Anthem ASO customers on how we can help support them in this endeavor. If you have questions, contact your Bim Account Executive. Please note that ASG/UMR and Anthem are handling the reporting requirements for KTA employer groups. No action is required for KTA employers at this time.
Aspirant: Aspirant will again be submitting all files for their customers (assuming customers are utilizing their preferred pharmacy vendors) for the 2022 reference year. We expect Aspirant to send customers a survey similar to the last filing to procure needed information to complete their filing. Bim Group will continue to assist in providing the needed data to customers to return to Aspirant.
UMR: UMR will be submitting the files for all customers who had active coverage during the 2022 reference year. UMR has sent a survey to all impacted customers (linked below) to gather needed information to complete their data for the upcoming filing. Bim Group will complete the UMR worksheet for customers to input needed data into the UMR survey link by the deadline of March 3, 2023. If you have questions, contact your Bim Account Executive.
UMR Worksheet | UMR Survey Link
We are providing this information as a reminder. You should have previously received information on your specific carrier / administrator’s approach to this reporting. If you have already completed any applicable surveys via the emails you previously received, you do not need to access and complete any of the links provided for reference above.
If you have questions regarding your obligations as an employer in this regard, please contact your Bim Account Executive / Manager.