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TITLE 28 | INSURANCE |
PART 1 | TEXAS DEPARTMENT OF INSURANCE |
CHAPTER 21 | TRADE PRACTICES |
SUBCHAPTER T | SUBMISSION OF CLEAN CLAIMS |
RULE §21.2815 | Failure to Meet the Statutory Claims Payment Period |
An HMO or preferred provider carrier that fails to comply with the requirements of §21.2807(b) of this title (relating to Effect of Filing a Clean Claim) and §21.2809(a) and (c) of this title (relating to Audit Procedures) shall pay the full amount of the billed charges submitted on the clean claim or pay the contracted penalty rate for late payment set forth in the contract between the provider or physician and the HMO or preferred provider carrier. Any amount previously paid or any charge for a non-covered service shall be deducted from the payment. This section shall not apply when there is failure to comply with a contracted claims payment period of less than 45 calendar days as provided in §21.2802(25)(A) of this title (relating to Definitions), and Article 3.70-3C, §3(m) or Article 20A.09(j) of the Insurance Code. |
Source Note: The provisions of this §21.2815 adopted to be effective May 23, 2000, 25 TexReg 4543 |