Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter T - SUBMISSION OF CLEAN CLAIMS
Section 21.2811 - Disclosure of Processing Procedures
Universal Citation: 28 TX Admin Code § 21.2811
Current through Reg. 50, No. 13; March 28, 2025
(a) In contracts with preferred providers, or in the physician or the provider manual or other document that sets forth the procedure for filing claims, or by any other method mutually agreed on by the contracting parties, an MCC must disclose to its preferred providers:
(1) the
address, including a physical address, where claims are to be sent for
processing;
(2) the telephone
number to which preferred providers' questions and concerns regarding claims
may be directed;
(3) any entity,
along with its address, including physical address and telephone number, to
which the MCC has delegated claim payment functions; and
(4) the mailing address, physical address,
and telephone number of any separate claims processing centers for specific
types of services.
(b) An MCC must provide no less than 60 calendar days prior written notice of any changes of address for submission of claims, and of any changes of delegation of claims payment functions, to all affected preferred providers.
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