Ins 9.42(7)(7)An insurer that complies with subs. (1) to (5), may permit another party to maintain any record required under sub. (6), but only if both of the following requirements are met:
Ins 9.42(7)(a)(a) The insurer includes and enforces the contractual provision described in sub. (4) (e).
Ins 9.42(7)(b)(b) The insurer produces any required record within 15 days after the office requests the record.
Ins 9.42(8)(8)An insurer shall maintain all of the following documents that relate to a silent provider network and shall make them available at the request of the commissioner:
Ins 9.42(8)(a)(a) Provider and provider network agreements, including addenda addressing reimbursement and discounts.
Ins 9.42(8)(b)(b) A listing of providers participating in additional group or individual discount contracts with the insurer.
Ins 9.42(8)(c)(c) Policy form numbers of those insurance products with silent discounts and associated marketing materials.
Ins 9.42(8)(d)(d) Claims administration guidelines for processing discounts including silent discounts.
Ins 9.42(8)(e)(e) Detailed documentation and explanation of claim system data fields and codes that identify silent discounts, other discount calculations, usual and customary calculations, and billed and paid amounts.
Ins 9.42(9)(9)An insurer offering a preferred provider plan that is not also a defined network plan shall comply with this section to the extent applicable.
Ins 9.42 HistoryHistory: Cr. Register, February, 2000, No. 530, eff. 3-1-00; corrections in (1) to (4) made under s. 13.93 (2m) (b) 7., Stats., Register November 2001 No. 551; CR 05-059: am. (1) to (3), (4) (a) and (e), (5) (a), and (6) (a), cr. (9) Register February 2006 No. 602, eff. 3-1-06; CR 06-083: am. (1) and (5) (a) Register December 2006 No. 612, eff. 1-1-07.