Regulatory Requirements

DHIN Regulations

In order to fulfill the requirements of its enabling legislation (Title 16, Chapter 103 of the Delaware Code), DHIN has published regulations on a number of topics. These regulations set forth, among other things, requirements associated with submitting data to and accessing data from DHIN:

• DHIN Regulations on Participation and Use of Data
• DHIN Regulations on Use of Clinical Data for Approved Analytic Purposes

Delaware Health Care Claims Database Regulations

In addition to the services it performs with respect to clinical data, DHIN also hosts the Delaware Health Care Claims Database (HCCD). In enabling the HCCD, the State of Delaware required certain insurance companies providing services in Delaware and to Delaware residents to submit claims information to DHIN’s HCCD to be used to improve the quality and decrease the cost of care in the State of Delaware. In addition to the enabling legislation (Title 16, Chapter 103, Subchapter II of the Delaware Code), the submission of data to DHIN for use in the HCCD and the use of data from the HCCD is governed by regulations:

• Delaware Health Care Claims Database Data Collection Regulation
• Delaware Health Care Claims Database Data Access Regulation

Prior Authorization Reporting

In an effort to improve transparency in the pre-authorization approval and decline rates by health plans, Delaware law (Title 18, Subchapter V of the Delaware Code) now requires the submission of prior authorization data to Delaware Health Information Network (DHIN) at least twice a year.

Health insurers, health benefit plans and health service corporations are required to report to DHIN de-identified statistics regarding pre-authorization approvals, denials and appeals in the specified format [linked below] by January 31st and July 31st of each calendar year. 

Q&A from conference call with DHIN and the Department of Insurance (1/31/18)

Pre-authorization reporting requirements and reporting spreadsheet