1. (a) An HMO or preferred provider carrier that fails to comply with §21.2807 of this title (relating to Effect of Filing a Clean Claim) for more than two percent of clean claims submitted to the HMO or preferred provider carrier is subject to an administrative penalty pursuant to the Insurance Code, §843.342(k) or Article 3.70-3C section 3I(k), as applicable.
2. (b) The percentage of the HMO or preferred provider carrier's compliance with §21.2807 of this title shall be determined on a quarterly basis and shall be separated into a compliance percentage for noninstitutional preferred provider claims and institutional preferred provider claims. Claims paid in compliance with §21.2809 of this title (relating to Audit Procedures) are not included in calculating the compliance percentage under this section.

Source Note:The provisions of this §21.2822 adopted to be effective October 5, 2003, 28 TexReg 8647.