Ill. Admin. Code tit. 50, pt. 2907, app B
a) Data File Format
The sample table in subsection (b) provides a list of the required data elements for illustrative purposes only. Do not submit your data in this format. All files must be submitted electronically as specified in Section 2907.40. A template is available for use on the Department's website at http://insurance.illinois.gov/.
b) Sample Table
NAIC # | FEIN | Company Name | Company Contact Name | Company Contact Phone Number | Contact email | Claims Opened | Medical Claims | Contested Claims |
FIELD: 1 | FIELD: 2 | FIELD: 3 | FIELD: 4a | FIELD: 4b | FIELD: 5 | FIELD: 6 | FIELD: 7 | FIELD: 8 |
Client-Attorney | Breakdown of lost time by claim | Adjuster Person-Hours | Claims Paid Time Frame | Medical Payment Time Frame | |||
FIELD 9 | FIELD: 10a | FIELD: 10b | FIELD: 10c | FIELD: 11 | FIELD: 12 | FIELD: 13a | FIELD: 13b |
Internal Defense Council | External Defense Council | Bill Review Expenses | Fee Schedule Expenses | Managed Care Expenses | |||
FIELD: 14a | FIELD 14b | FIELD: 15a | FIELD: 15b | FIELD: 16a | FIELD: 16b | FIELD: 17 | FIELD: 18 |
Internal Medical Nurse Management | External Medical Nurse Management | Medical Exam Expenses | Internal Utilization Review Expenses | External Utilization Review Expenses | ||
FIELD: 19a | FIELD: 19b | FIELD: 20a | FIELD: 20b | FIELD: 21 | FIELD: 22 | FIELD: 23 |
Ill. Admin. Code tit. 50, pt. 2907, app B