SECTION 21.2805. Requests for Additional Information from Other Sources

(a) If an MCC requests additional information from a person other than the preferred provider who submitted the claim, the MCC must provide to the preferred provider who submitted the claim a notice containing the name of the physician, the provider, or the other entity from which the MCC is requesting information. The MCC may not withhold payment beyond the applicable statutory claims payment period pending receipt of information requested under subsection (b) of this section. If, on receiving information requested under this subsection the MCC determines that there was an error in payment of the claim, the MCC may recover any overpayment under §21.2818 of this title (relating to Overpayment of Claims).

(b) An MCC must request that the entity responding to a request made under this section attach a copy of the request to the response. If the request for additional information was submitted electronically in compliance with applicable federal requirements concerning electronic transactions, the responding entity must submit the response in compliance with those requirements, if applicable.

(c) Receipt of a request or a response to a request under this section is subject to the provisions of §21.2816 of this title (relating to Date of Receipt).

Source Note: The provisions of this §21.2805 adopted to be effective October 5, 2003, 28 TexReg 8647; amended to be effective February 16, 2014, 39 TexReg 747