28 Tex. Admin. Code § 21.2822 - Administrative Penalties

(a) An MCC that fails to comply with § 21.2807 of this title (relating to Effect of Filing a Clean Claim) for more than 2 percent of clean claims submitted to the MCC is subject to an administrative penalty under Insurance Code § 843.342(k) or § 1301.137(k), as applicable.

(b) The percentage of the MCC's compliance with § 21.2807 of this title must be determined on a quarterly basis and must 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.

Notes

28 Tex. Admin. Code § 21.2822

The provisions of this §21.2822 adopted to be effective October 5, 2003, 28 TexReg 8647; amended to be effective February 16, 2014, 39 TexReg 747