Texas Register
TITLE 28 INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 21TRADE PRACTICES
SUBCHAPTER TSUBMISSION OF CLEAN CLAIMS
RULE §21.2815Failure to Meet the Statutory Claims Payment Period
ISSUE 05/19/2000
ACTION Final/Adopted
Preamble Texas Admin Code Rule
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.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 3, 2000

TRD-200003121

Lynda Nesenholtz

General Counsel

Texas Department of Insurance

Effective date: May 23, 2000

Proposal publication date: December 17, 1999

For further information, please call: (512) 463-6327

 

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