How to Get Claims Data For Your District

With Senate Bill 1444, education employers have more flexibility in choosing health care for their employees. We're committed to ensuring you have the tools to make informed, strategic decisions. This way you control your future, your way.

To compare TRS-ActiveCare to other options in the market, you can request claims data. The data will show medical and prescription costs specific to your employees. This information can only be used for bidding out non-TRS group health plans.

It's vital information for your decision, especially if you choose to self-fund. It affects what you spend, and how other market plans will calculate premiums after year one or two.

Remember: The decision to leave TRS-ActiveCare is a five-year (minimum) commitment. Consider your options carefully.

New Streamlined Process in 2024

TRS has streamlined the request and reporting process for claims data in 2024. In this new automated process, employers can request and receive a Summary Health Plan Report within the RE Portal already used by employers.

To restrict access to HIPAA data to only essential users, there is a new Health Admin role in the RE portal. This role is assigned by the Web Administrator for the Reporting Entity.

The Health Admin must be an employee of the Reporting Employer and authorized to:
(1) complete the Plan Sponsor Certification and Summary Health Information Request Form
(2) receive an encrypted copy of the report.

The Health Administrator (Health Admin) can digitally sign the information request form within the RE Portal. This signature will trigger creation of the report.

After reviewing the report, within 10 business days TRS will make the report available in an encrypted zip file and store it in the new Document Center of the RE Portal. At the same time, TRS will send the password to decrypt the file to the Head of Institution's email address on file at the time the request is fulfilled.

The Health Admin must obtain the password to decrypt the file from their Head of Institution. For security reasons, TRS staff will not provide this password directly to the Health Admin. This will ensure that HIPAA protected data is provided to employees authorized only by the Head of Institution on file to access this data.

What to Know

There’s no cost to a data request if the employer has participated in TRS-ActiveCare for the last 36 months
You can request data twice per state fiscal year (Sept. 1 – Aug. 31)
TRS will provide data within ten business days after receipt of the request

Critical information: Data can include Protected Health Information under federal and state laws, like the Health Insurance Portability and Accountability Act of 1996 (HIPAA). For the most detailed data, employers must develop and maintain certain documents. The documents must prescribe and restrict uses and disclosures of such information laid out by 45 CFR § 164.504(f).

You must complete a certification document to receive this type of data. Because it's federal policy, TRS can't answer questions or provide legal guidance about this certification.

Summary Health Information

This is the most detailed option. It provides 36 months of medical, pharmacy, and enrollment data. It includes high-cost claimant information. Employers must complete the Protected Health Information certification for this data.

Changes since 2021: We received feedback that many districts want expanded data to review before making a decision. In response, TRS added new fields. These include:

The name and script count of the top 100 most expensive drugs to the plan for each district. This includes whether the drug is considered specialty, brand, or generic.
The plan paid amount by month for medical spending by major category of spending (inpatient, outpatient, professional, other).
The top 10 facilities based on plan paid. This includes the top 10 for inpatient, outpatient, physician, and other categories for a total of 40 providers.

High-cost claimants are employees with $50,000+ in claims. This includes the plan year to date, and then the most complete plan year. See the self-funding guide to understand how these employees may be excluded from coverage after the first claims year.

To receive this data, employers must:

Login to the TRS reporting employer portal and download the claims data request form
Complete the Plan Sponsor Certification and Summary Health Information Request Form
Submit the form to the contact identified on the forms in the portal
Execute an agreement with the TRS designated entity to receive the data. See instructions on forms in reporting entity (RE) portal for requesting a copy of this agreement

The form will be available on the RE portal on Aug. 15, 2021. For issues logging into the RE portal, or to request the form before that date, please contact healthcarecomm@trs.texas.gov.

Tips

To ensure a smooth process, please review and confirm the information listed in the RE Portal for you head of institution before submitting a request.

To assign the Health Admin role as a web administrator, see this guide on the TRS website.

Health Admins must follow this process for each data request.

For questions or issues specific to requesting health care data, please contact healthcarecomm@trs.texas.gov.

As before, Reporting Employers are limited to a total of two Summary Health Information requests per State Fiscal Year (Sept. 1-Aug. 31)

The data within the report will remain nearly identical to the prior version with some small updates. The new template is available here.

The data being provided is protected by HIPAA and can only be used for purpose of obtaining premium bids or quotes outside of TRS-ActiveCare.

Previously there was a second option for a de-identified report that required manual review by a de-identification expert and was rarely requested by employers. To streamline the process for obtaining critical data needed to get quotes, TRS will only provide the option to request Summary Health Plan Reporting. However, TRS will continue to publish extensive data about plan performance in its annual TRS Health Benefits Report and other public venues.

An employer must have participated in TRS-ActiveCare for at least 36 months to request claims data.

Quick Questions

Can any employer who participates in TRS-ActiveCare request claims data?
No. An employer must have participated in TRS-ActiveCare for at least 36 months.

Does an employer have to pay for claims data?
No. TRS will provide claims data for free, as long as requests are in the outlined frequency.

How often can employers request claims data?
Twice per state fiscal year, which runs from Sept. 1 to Aug. 31.

How long will it take to get claims data?
Ten business days after TRS receives the request as outlined.

What type of data do employers have access to?
There are two types – Summary Health Information and De-Identified Data. Please read the designated sections for these for more details.

Summary Health Information has been expanded and updated as of Oct. 7, 2022.

See an example of what the report will look like here.

Where can employers get more information about Senate Bill 1444?
Visit our Initial Guidance webpage. Employers can also review our self-funding guide, which has information about what to expect if they leave TRS-ActiveCare.

Who should an employer contact for more information?
Send inquiries to healthcarecomm@trs.texas.gov. Employers can also contact their District Ambassador (DA) for guidance on how to get the information they want/need.