This subchapter applies to all paper and electronic claims submitted by contracted physicians or providers for services or benefits provided to insureds of preferred provider carriers and enrollees of health maintenance organizations. The purpose of this subchapter is to specify the definitions and procedures necessary to implement Article 3.70-3C (Preferred Provider Benefit Plans) and Chapter 20A of the Insurance Code relating to clean claims and prompt payment of physician and provider claims.

Source Note:The provisions of this §21.2801 adopted to be effective May 23, 2000, 25 TexReg 4543.