Effect of Filing Deficient Claim

If an MCC determines that a submitted claim is deficient, the MCC must notify the preferred provider submitting the claim that the claim is deficient within 45 calendar days of the MCC's receipt of the nonelectronic claim, or within 30 days of receipt of an electronic claim. If an MCC determines that a claim for a prescription benefit is deficient, the MCC must notify the provider that the claim is deficient within 21 calendar days of the MCC's receipt of the nonelectronic claim, or within 18 days of receipt of an electronic 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; amended to be effective February 16, 2014, 39 TexReg 747.