If a submitted claim is determined by an HMO or preferred provider carrier to be deficient, the HMO or preferred provider carrier shall notify the physician or 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. The HMO or preferred provider carrier and the physician or provider may agree to a different time period, not to exceed 45 calendar days, for notification that a claim is deficient. If an electronically submitted claim for a prescription benefit is determined by an HMO or preferred provider carrier 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.