(a) Submitting entity requirements. Unless exempted by the Insurance Commissioner in accordance with subsection (c) of this section or by the explicit language of this part, a submitting entity shall submit to the State Insurance Department through the administrator a completed data set for an enrollment file, a medical claims file, a dental claims file, a pharmacy claims file, a provider file, and a validation report in accordance with:

1. (1) This section; and
2. (2) The requirements outlined in the Data Submission Guide.

(b) Data submission timing. Submitting entities shall provide data in accordance with the following schedule:

1. (1) Test files for submitting entities must be submitted no later than January 1, 2016;

2. (2)

   1. (A) Historical data and regular quarterly submission will commence following submission of test files according to the submission schedule in Appendix A.
   2. (B) For purposes of the submission schedule the following groupings apply:

(i) Group 1 means submitting entities listed in 23 CAR § 131-103(21)(B)(i) with at least one hundred thousand (100,000) covered individuals as of December 31, 2015, and entities listed in 23 CAR § 131-103(21)(B)(ii), (iii), (iv), and (vi);

1. (ii) Group 2 means submitting entities listed in 23 CAR § 131-103(21)(B)(i) with at least twenty-five thousand (25,000) covered individuals but fewer than one hundred thousand (100,000) covered individuals as of December 31, 2015;

   1. (iii) Group 3 means submitting entities listed in 23 CAR § 131-103(21)(B)(i) with at least ten thousand (10,000) covered individuals but fewer than twenty-five thousand (25,000) covered individuals as of December 31, 2015; and

      1. (iv) Group 4 means submitting entities listed in 23 CAR § 131-103(21)(B)(v) and submitting entities listed in 23 CAR § 131-103(21)(B)(i) with at least two thousand (2,000) covered individuals but fewer than ten thousand (10,000) covered individuals as of December 31, 2015;
2. (3) Unless otherwise exempted under subsection (c) of this section, submitting entities must submit data according to the established patterns identified in the submission schedule in Appendix A for future years not explicitly listed in the schedule; and

3. (4) Entities qualifying in more than one (1) group listed in subdivision (b)(2) of this section must submit claims for all covered individuals according to the schedule listed for the first group in which the entity qualifies.

   1. (c) Submitting entity exemptions.

4. (1)

   1. (A) An entity with fewer than two thousand (2,000) covered individuals as of December 31 of the previous calendar year will not be required to submit data in accordance with this part.
   2. (B) For purposes of determining whether an entity is subject to the requirements of this part and for data submission timing in subsection (b) of this section, entities must aggregate the number of covered individuals for all companies at the Group Code level as defined by the National Association of Insurance Commissioners.
   3. (C) Entities that offer medical, dental, and pharmaceutical benefits, or any combination thereof, under separate or combined plans will count all covered individuals, irrespective of the comprehensiveness of the plan, toward the two thousand (2,000) covered individuals threshold.

5. (2)

   1. (A) The Arkansas Workers' Compensation Commission is exempt from submitting a provider file as required by this section.
   2. (B) Until further notice, employer self-funded health plans are exempt from all requirements in this part.

6. (3)

   1. (A) The commissioner may, for good cause, grant an exemption to a submitting entity, or to a class of which the entity is a member, for all or some of the requirements of this part.
   2. (B) "Good cause" includes without limitation pending litigation that may preempt application of Acts 2015, No. 1233, to a submitting entity.
   3. (C) The commissioner will respond in writing within thirty (30) days to any exemption request.
7. (4) If an entity does not believe it meets the definition of a submitting entity herein or does not believe it meets the two thousand (2,000) covered individuals threshold, that entity may dispute the commissioner’s decision in accordance with the administrative procedures of the State of Arkansas.