28 Tex. Admin. Code § 21.2819 - Catastrophic Event
(a) An MCC, a
physician, or a provider must notify the Texas Department of Insurance (TDI)
if, due to a catastrophic event, it is unable to meet the deadlines in §
21.2804 of this title (relating to
Requests for Additional Information from Treating Preferred Provider), §
21.2806 of this title (relating to
Claims Filing Deadline), §
21.2807 of this title (relating to
Effect of Filing a Clean Claim), §
21.2808 of this title (relating to
Effect of Filing Deficient Claim), §
21.2809 of this title (relating to
Audit Procedures), and §
21.2815 of this title (relating to
Failure to Meet the Statutory Claims Payment Period), as applicable. The entity
must send a request required under this section to TDI within five days of the
date the catastrophic event began substantially interfering with the normal
business operations of the entity, or as specified in a notice published by the
commissioner regarding the catastrophic event.
(b) An entity must send the request required
under this section to TDI by email to PromptPay@tdi.texas.gov, unless an
alternative electronic method is provided by TDI for a specified event. The
request must:
(1) be from:
(A) if for a physician or a provider, the
physician, provider, office manager, administrator, or their designee;
or
(B) if for an MCC, a corporate
officer or a corporate officer's designee;
(2) identify the specific nature of the
catastrophic event;
(3) identify
the first date the catastrophic event caused an interruption in the claims
submission or processing activities of the physician, provider, or
MCC;
(4) identify the date the
physician, provider, or MCC reasonably expects to resume normal business
operations;
(5) state how the
catastrophic event is substantially interfering with the entity's normal
business operations;
(6) include
the contact information for the physician, provider, or MCC, including each
entity's name, email address, phone number, and:
(A) if for a physician or provider, the
national provider identification number; or
(B) if for an MCC, the entity's NAIC number;
and
(7) include the
physical address of each business or practice location affected by the
catastrophic event.
(c) A
request under this section tolls the applicable deadlines in §§
21.2804,
21.2806,
21.2807,
21.2808,
21.2809, and
21.2815 of this title for the
number of days between the date identified in subsection (b)(3) of this section
and the earlier of any date specified in a notice published by the commissioner
or listed in TDI's approval of a request, or the date the entity is able to
resume normal business operations.
(d) If a catastrophic event is expected to
continue to substantially interfere with an entity's normal business operations
past the date in a notice published by the commissioner or in TDI's approval of
an extension request, then the entity must send an additional request meeting
the requirements of this section to TDI at least three business days before the
expiration of the existing extension. The new request must explain why an
additional extension is needed. If an entity resumes normal business operations
sooner than the date the extension would otherwise expire, the entity must send
a notification to TDI of the date the entity resumed normal business
operations, no later than three business days after that date.
(e) TDI will contact the physician, provider,
or MCC if more information is needed for any request received. TDI may
disapprove a request if the nature of the event does not meet the definition of
a catastrophic event that substantially interferes with the entity's normal
business operations. TDI may limit a requested extension if the identified
duration of interruption to normal business operations is not proportional to
the nature of the catastrophic event.
Notes
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