| (a) An MCC, a physician, or a provider must notify
the Texas Department of Insurance (TDI) if, due to a catastrophic
event, it is unable to meet the deadlines in §21.2804 of this
title (relating to Requests for Additional Information from Treating
Preferred Provider), §21.2806 of this title (relating to Claims
Filing Deadline), §21.2807 of this title (relating to Effect
of Filing a Clean Claim), §21.2808 of this title (relating to
Effect of Filing Deficient Claim), §21.2809 of this title (relating
to Audit Procedures), and §21.2815 of this title (relating to
Failure to Meet the Statutory Claims Payment Period), as applicable.
The entity must send a request required under this section to TDI
within five days of the date the catastrophic event began substantially
interfering with the normal business operations of the entity, or
as specified in a notice published by the commissioner regarding the
catastrophic event.
(b) An entity must send the request required under
this section to TDI by email to PromptPay@tdi.texas.gov, unless an
alternative electronic method is provided by TDI for a specified event.
The request must:
(1) be from:
(A) if for a physician or a provider, the physician,
provider, office manager, administrator, or their designee; or
(B) if for an MCC, a corporate officer or a corporate
officer's designee;
(2) identify the specific nature of the catastrophic
event;
(3) identify the first date the catastrophic event
caused an interruption in the claims submission or processing activities
of the physician, provider, or MCC;
(4) identify the date the physician, provider, or MCC
reasonably expects to resume normal business operations;
(5) state how the catastrophic event is substantially
interfering with the entity's normal business operations;
(6) include the contact information for the physician,
provider, or MCC, including each entity's name, email address, phone
number, and:
(A) if for a physician or provider, the national provider
identification number; or
(B) if for an MCC, the entity's NAIC number; and
(7) include the physical address of each business or
practice location affected by the catastrophic event.
(c) A request under this section tolls the applicable
deadlines in §§21.2804, 21.2806, 21.2807, 21.2808, 21.2809,
and 21.2815 of this title for the number of days between the date
identified in subsection (b)(3) of this section and the earlier of
any date specified in a notice published by the commissioner or listed
in TDI's approval of a request, or the date the entity is able to
resume normal business operations.
(d) If a catastrophic event is expected to continue
to substantially interfere with an entity's normal business operations
past the date in a notice published by the commissioner or in TDI's
approval of an extension request, then the entity must send an additional
request meeting the requirements of this section to TDI at least three
business days before the expiration of the existing extension. The
new request must explain why an additional extension is needed. If
an entity resumes normal business operations sooner than the date
the extension would otherwise expire, the entity must send a notification
to TDI of the date the entity resumed normal business operations,
no later than three business days after that date.
(e) TDI will contact the physician, provider, or MCC
if more information is needed for any request received. TDI may disapprove
a request if the nature of the event does not meet the definition
of a catastrophic event that substantially interferes with the entity's
normal business operations. TDI may limit a requested extension if
the identified duration of interruption to normal business operations
is not proportional to the nature of the catastrophic event.
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| Source Note: The provisions of this §21.2819 adopted to be effective October 5, 2003, 28 TexReg 8647; amended to be effective February 16, 2014, 39 TexReg 747; amended to be effective November 7, 2021, 46 TexReg 7408; amended to be effective March 18, 2024, 49 TexReg 1720 |
