| (a) A written communication, including a claim, referenced
under this subchapter is subject to and must comply with this section
unless otherwise stated in this subchapter.
(b) An entity subject to these rules may deliver written
communications as follows:
(1) submit the communication by United States mail,
first class; by United States mail, return receipt requested; or by
overnight delivery;
(2) submit the communication electronically and maintain
proof of the electronically submitted communication;
(3) if the entity accepts facsimile transmissions for
the type of communication being sent, fax the communication and maintain
proof of facsimile transmission; or
(4) hand deliver the communication and maintain a copy
of the signed receipt acknowledging the hand delivery.
(c) If a communication is submitted by United States
mail, first class, the communication is presumed to have been received
on the fifth day after the date the communication is submitted, or,
if the communication is submitted using overnight delivery service
or United States mail return receipt requested, on the date the delivery
receipt is signed.
(d) If a communication other than a claim is submitted
electronically, the communication is presumed received on the date
of submission. Communications electronically submitted after the receiving
entity's normal business hours are presumed received the following
business day.
(e) If a claim is submitted electronically, the claim
is presumed received on the date of the electronic verification of
receipt by the MCC or the MCC's clearinghouse. If the MCC's clearinghouse
does not provide a confirmation of receipt of the claim or a rejection
of the claim within 24 hours of submission by the physician, or the
provider, or the physician's or provider's clearinghouse, the physician's
or provider's clearinghouse must provide the confirmation. The physician's
or provider's clearinghouse must be able to verify that the claim
contained the correct payor identification of the entity to receive
the claim.
(f) If a communication is faxed, the communication
is presumed to have been received on the date of the transmission
acknowledgement. Communications faxed after the receiving entity's
normal business hours are presumed received the following business
day.
(g) If a communication is hand delivered, the communication
is presumed to have been delivered on the date the delivery receipt
is signed.
(h) Any entity submitting a communication under subsection
(b)(1) - (4) of this section may choose to maintain a mail log to
provide proof of submission and establish date of receipt. The entity
must fax or electronically transmit a copy of the mail log, if used,
to the receiving entity at the time of the submission of a communication
and include another copy with the relevant communication. The log
must identify each separate claim, request for information, or response
included in a batch communication. The mail log must include the following
information: name of claimant; address of claimant; telephone number
of claimant; claimant's federal tax identification number; name of
addressee; name of MCC; designated address; date of mailing or hand
delivery; subscriber name; subscriber ID number; patient name; date(s)
of service or occurrence; delivery method; and claim number, if applicable.
|
| Source Note: The provisions of this §21.2816 adopted to be effective October 2, 2001, 26 TexReg 7542; amended to be effective October 5, 2003, 28 TexReg 8647; amended to be effective February 16, 2014, 39 TexReg 747 |
