SECTION 21.2822. Administrative Penalties

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(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.

Source Note: 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

                    
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