| (a) Separate reporting. Within the "MH/SUD Parity Rule
Division 2 Data Collection Reporting Form" template, in the worksheet
titled "Claims and Utilization Review," an issuer must separately
report claims and requests for utilization review for medical/surgical
and MH/SUD.
(b) ICD diagnosis codes. In the worksheet titled "Claims
and Utilization Review," all claims and utilization review requests
with mental, behavioral, and neurodevelopmental disorder diagnosis
codes in the International Classification of Diseases and Related
Health Problems should be categorized as MH/SUD. Claims and utilization
review requests with all other ICD diagnostic codes should be categorized
as medical/surgical.
(c) Reporting classifications. Claims and requests
for utilization review are to be identified in the worksheet as belonging
in one the following reporting classifications:
(1) inpatient, in-network;
(2) inpatient, out-of-network;
(3) outpatient, in-network, consisting of:
(A) office visits; and
(B) all other;
(4) outpatient, out-of-network, consisting of:
(A) office visits; and
(B) all other;
(5) emergency; and
(6) prescription drugs.
(d) Unneeded information. Where appropriate, an issuer
may enter "N/A" in the worksheet. For example, indemnity plans will
not have data for in-network classifications, and HMOs with no POS
component and EPOs will not have data for out-of-network classifications.
An issuer of those plans may therefore enter N/A where that data is
requested.
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