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You are here: Home . rules . 2003 . 0915-059
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Subchapter T. Submission of Clean Claims

§§21.2804 ­ 21.2806 and 21. 2818 ­ 21.2820

The Commissioner of Insurance adopts the repeal of §§21.2804 ­ 21.2806 and 21.2818 - 21.2820 concerning submission of clean claims. The repeal is adopted without changes to the proposal as published in the July 4, 2003 issue of the Texas Register (28 TexReg 5098) and will not be republished. The commissioner adopted emergency rules repealing these sections effective August 16, 2003 in compliance with Senate Bill (SB) 418, 78 th Regular Legislative Session. These emergency rules were published in the August 29, 2003 issue of the Texas Register (28 TexReg 7043). The emergency repeal will be withdrawn at the time this adopted repeal becomes effective. Contemporaneously with this adopted repeal, adopted amendments to §§21.2801 ­ 21.2803, 21.2807 ­ 21.2809, and 21.2811 ­ 21 . 2817, and adopted new §§21.2804 ­ 21.2806, 21.2818, 21.2819 and 21.2821 ­ 21.2825 are published elsewhere in this issue of the Texas Register .

This repeal is necessary so that new §§21.2804 ­ 21.2806 and 21.2818 ­ 21.2820 may be adopted which will implement the provisions of SB 418.

The provisions of repealed §§21.2819 and 21.2820 are adopted as new §§21.2824 and 21.2825 and are published elsewhere in this issue of the Texas Register . The provisions of SB 418, which require standardization of clean claim requirements, are inconsistent with repealed §§21.2804 ­ 21.2806 and 21.2818, which allowed for carrier-specific clean claim elements and attachments after proper disclosure.

No comments were received on the proposed repeal.

The repeal of §§21.2804 ­ 21.2806, and 21.2818 ¨ 21.2820 is adopted under the Insurance Code Article 3.70-3C and §§36.001, 843.336, and 843.3385. Article 3.70-3C provides that the commissioner may adopt rules to implement the article as it relates to the prompt payment of claims by a preferred provider carrier, provides a standard format for the filing of clean claims and does not allow for attachments, but permits insurers, in lieu of requiring attachments with clean claims, to request additional information after receiving a clean claim . Section 36.001 provides that the Commissioner of Insurance may adopt any rules necessary and appropriate to implement the powers and duties of the Texas Department of Insurance under the Insurance Code and other laws of this state. Section 843.336 provides the standardized format for a clean claim in the Health Maintenance Organization (HMO) Act and does not allow for attachments. Section 843.3385 allows an HMO to request additional information after receiving a clean claim in lieu of the prior statute´s provisions for requiring attachments as part of a clean claim.

§21.2804. Disclosure of Necessary Attachments.

§21.2805. Disclosure of Additional Clean Claim Elements.

§21.2806. Disclosure of Revision of Data Elements, Attachments, or Additional Clean Claim Elements.

§21.2818. Disclosure Formats.

§21.2819. Applicability.

§21.2820. Severability.



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