DHS 120.15(2)(b)9.9. The usual and customary charges for office visits, routine tests and preventive measures and frequently occurring procedures, as specified by the department.

DHS 120.15(2)(c)(c) If the data specified in par. (b) is not available from the department of safety and professional services, or is not available for the desired time interval or in the required format, the department shall require the health care provider to submit that information directly to the department or its designee in a format prescribed by the department.

DHS 120.15(2)(d)(d) The department shall consult with each applicable health care provider group specified in sub. (1), through a technical advisory committee or trade association, before the department collects data directly from members of that health care provider group.

DHS 120.15(3)(a)(a) The department shall require that information specified in sub. (2) be submitted to the department at least once every 3 years according to a schedule developed by the department. The department may require that the requested information be submitted on an annual or biennial basis according to a schedule developed by the department.

DHS 120.15(3)(b)(b) The department may grant an extension of a deadline specified in par. (a) for submission of health care provider information only when the health care provider adequately justifies to the department the health care provider’s need for additional time. In this paragraph, “adequate justification” means a delay due to a labor strike, fire, natural disaster or catastrophic computer failure. A health care provider desiring an extension shall submit a request for an extension in writing to the department at least 10 calendar days prior to the date that the data are due. The department may grant an extension for up to 30 calendar days. Health care providers who have been granted an extension by the department shall submit their data directly to the department.

DHS 120.15 NoteNote: Health care providers who are required to send their information directly to the department should use the following address: Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin.

DHS 120.15(4)(4) Data verification, review and comment procedures. Health care providers specified in sub. (1) shall verify or correct information contained on their survey. The department shall verify questionable data by contacting the applicable health care provider.

DHS 120.15 NoteNote: With the exception of s. DHS 120.15, under s. 153.78 (2), Stats., and s. DHS 120.10 (3) (b), the department may assess fines on health care providers that do not submit the data specified in this subchapter on a timely basis. Health care providers may be subject to a fine of $100 per day per type of data that has not been submitted to the Department under this subchapter.

DHS 120.15 HistoryHistory: Cr. Register, December, 2000, No. 540, eff. 1-1-01; correction in (2) (c) made under s. 13.92 (4) (b) 6., Stats., Register February 2012 No. 674.

DHS 120.16(1)(1) Applicability. This section applies to health care plans that either voluntarily submit health care plan data directly to the department or submit it to the department through the data collection of other state agencies.

DHS 120.16(2)(2) Data to be collected. The department shall collect all of the following types of data from each participating health care plan or through a designated state agency:

DHS 120.16(2)(a)(a) Financial data. Information regarding the financial status of the health care plan secured under the authority of the commissioner of insurance.

DHS 120.16(2)(b)(b) Market conduct. Information regarding the conduct of the health care plan in the marketplace secured under the authority of the commissioner of insurance.

DHS 120.16(2)(c)(c) Quality indicators. Measures of quality of care provided by the health care plan from the office of the commissioner of insurance.

DHS 120.16 NoteNote: Quality indicators include Health Plan Employer Data and Information (HEDIS) measures and Consumer Assessment of Health Plans (CAHPS) patient satisfaction measures.

DHS 120.16(2)(d)(d) Grievances and complaints data. Measures of grievances and complaints filed by enrollees of the health care plan from the office of the commissioner of insurance and the department of employee trust funds.

DHS 120.16(3)(3) Data submission procedures. State agencies specified in sub. (2) shall forward to the department information specified in sub. (2) in electronic files on an annual basis. The information shall be in a format that has been agreed upon by the department and the state agencies.

DHS 120.16(4)(4) Data verification, review and comment procedures. Each of the state agencies specified in sub. (2) shall verify that the information provided to the department has been reviewed and meets the agency’s standards for release to the public.

DHS 120.16(5)(5) Data adjustment methods. The department shall include caveats regarding the information the department releases to the public, when needed, to assist consumers in understanding the differences in populations served by the health care plans. Caveats may include references to large populations, such as commercial, medical assistance or medicare populations.