If an HMO or preferred provider carrier determines a submitted claim to be deficient, the HMO or preferred provider carrier shall notify the preferred provider submitting the claim that the claim is deficient within 45 calendar days of the HMO's or preferred provider carrier's receipt of the claim, or within 30 days of receipt of an electronic claim. If an HMO or preferred provider carrier determines an electronically submitted claim for a prescription benefit to be deficient, the HMO or preferred provider carrier shall notify the provider within 21 calendar days of the HMO's or preferred provider carrier's receipt of the claim.

Source Note:The provisions of this §21.2808 adopted to be effective May 23, 2000, 25 TexReg 4543; amended to be effective October 5, 2003, 28 TexReg 8647.