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Claims Filing and Deadlines | Contracts | Clearinghouses and Third Party Administrators | Form-Specific Questions | General Prompt Pay Questions | Other | Payment | Preauthorization and Verification | Privacy Issues Q: If a payer experiences a catastrophic event, is the payer required to notify physicians and providers?

TDI and the stakeholder associations are making extensive educational efforts to inform all physicians and providers of the requirements of this law.

Q: If an electronic claim is submitted to a clearinghouse, which is the payer's designated claim address, and the clearinghouse changes the electronic claim to paper before forwarding it to the payer, what is the appropriate statutory deadline for payment to a preferred provider - 30 days for an electronic claim, or 45 days for a paper claim?

A: If an electronic claim that is subject to the prompt pay laws is submitted and received at the payer's designated claim address in a HIPAA-compliant electronic format, then the claim is subject to the 30-day prompt pay timeframe for electronic claims.

Q: What is the filing deadline for a preferred provider to appeal an underpayment by a MCC?

A: A preferred provider that receives less than 100 percent of the contracted rate with a notice of intent to audit must notify the MCC within 270 days in compliance with 28 TAC §21.2815(f)(2) to qualify to receive a penalty for the underpaid amount.

Q: What is the filing deadline to appeal an MCC's request for refund of overpayment, or following an audit under 28 TAC §21.2818?

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