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18-Feb-2018 22:03

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Claims filed for services rendered to persons who are not covered under a MCC plan are subject to the claim filing deadlines in Chapter 146, Title 6, Civil Practices and Remedies Code.TDI and the stakeholder associations are making extensive educational efforts to inform all physicians and providers of the requirements of this law.A provider and a MCC may agree by contract to extend the period for submitting a claim.A MCC must accept, as proof of timely filing, information from another carrier showing the claim was timely filed. Q: The rule at 28 TAC §21.2806(c), states that if a claim is timely filed to the wrong carrier that proof of submission can be used as proof of timely filing. A: TIC §1301.102(c) and §843.337(a) and 28 TAC §21.2806(c), require Health Maintenance Organizations and Preferred Provider Benefit Plan carriers to accept as proof of timely filing a claim that was timely filed to another HMO or PPBP carrier.Q: 28 Texas Administrative Code §21.2816(h) was amended to not require a provider to maintain a mail log.

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A: If an electronic claim that is subject to the prompt pay laws is submitted and received at the payer's designated claim address in a HIPAA-compliant electronic format, then the claim is subject to the 30-day prompt pay timeframe for electronic claims.

However, in order to avoid disputes and to allow TDI to take action under these rules, there must be some documentation that the claim was actually mailed.