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Texas Department of Insurance
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Subchapter T. Submission of Clean Claims

§§21.2804 ­ 21.2806 and 21. 2818 ­ 21.2820

The Texas Department of Insurance proposes the repeal of §§21.2804 ­ 21.2806 and 21.2818 - 21.2820 concerning submission of clean claims. Contemporaneously with this proposed repeal, amendments to §§21.2801-21.2803, 21.2807-21.2809, and 21.2811-2817, and proposed 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 proposed repeal is necessary so that new §§21.2804 ­ 21.2806 and 21.2818 - 21.2820 may be adopted which will implement the provisions of Senate Bill 418, 78 th Legislative Session. The current provisions of proposed repealed §§21.2819 and 21.2820 will be proposed as new §§21.2824 and 21.2825. The provisions of SB 418, which require standardization of clean claim requirements, are inconsistent with §§21.2804 ­ 21.2806 and 21.2818, which allowed for carrier-specific clean claim elements and attachments after proper disclosure.

Kimberly Stokes, Senior Associate Commissioner, Life, Health and Licensing Program, has determined that for each year of the first five years the repeal is in effect, there will be no fiscal impact to state and local governments as a result of the enforcement or administration of the rule. There will be no measurable effect on local employment or the local economy as a result of the proposal.

Ms. Stokes has determined that for each year of the first five years the repeal is in effect, the public benefits anticipated as a result of the proposed repeal will be the adoption of the new sections implementing SB 418 and the repeal of sections for which their is no longer statutory authority. There is no anticipated economic cost to persons required to comply with the proposed repealed sections. The department does not believe it is either legal or feasible to exempt small businesses or micro-businesses from the requirements of this proposed repeal. The implementation of SB 418 is legally necessary for all carriers, regardless of size.

To be considered, written comments on the proposal must be submitted no later than 5:00 p.m. on August 4, 2003 to Gene C. Jarmon, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P. O. Box 149104 , Austin , Texas 78714-9104 . An additional copy of the comment must be simultaneously submitted to Kimberly Stokes, Mail Code 102-7A, Texas Department of Insurance, P.O. Box 149104 , Austin , Texas 78714-9104 . A request for a public hearing should be submitted separately to the Office of the Chief Clerk.

The repeal of §§21.2804 ­ 21.2806, 21.2818 - 21.2820 is proposed 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 with no required attachments, and allows 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 rules necessary and appropriate to implement the duties and powers of the Texas Department of Insurance. Section 843.336 provides the standardized format for a clean claim in the 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.

The following sections are affected by this proposal:

Rule Statute

§§21.2804 ­ 21.2806, 21.2818 - 21.2820 Insurance Code Article 3.70-3C and §§843.336, 843.3385

§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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