Texas Register, Volume 38, Number 46, Pages 8023-8312, November 15, 2013 Page: 8,108
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lating proposed subparagraphs (KK) and (MM) because they are
no longer relevant.
Existing 21.2803(b)(2). Redesignation of predecessor form
CMS-1500 (08/05); elimination of obsolete form CMS-1500
(12/90). The rule is amended to delete the text of existing
paragraph 21.2803(b)(2) in order to eliminate all references to
obsolete form CMS-1500 (12/90).
The amendments also redesignate existing paragraph
21.2803(b)(1) as 21.2803(b)(2) to address the phase-out pe-
riod for form CMS-1 500 (08/05). New paragraph 21.2803(b)(2)
specifies that physicians and noninstitutional providers filing or
refiling nonelectronic claims before the later of April 1, 2014,
or the earliest compliance date required by CMS must use
predecessor form CMS-1500 (08/05). The amendments also
allow a physician or noninstitutional provider to begin submitting
claims using form CMS-1500 (02/12) when notified that an MCC
is prepared to accept claims filed or refiled on the new form.
There are nonsubstantive amendments throughout
21.2803(b)(2) to conform the paragraph to the current
codification and language of the Insurance and Administrative
Codes, to update internal references, and to make minor
language, punctuation, and grammatical changes to make the
rules easier to read, understand, and use.
21.2803(b)(3). Claim form UB-04. The proposed amendments
to this paragraph eliminate timeframes that are no longer rele-
vant because the UB-04 claim form is currently the only form
institutional providers may use.
21.2803(b)(4). Predecessor claim form UB-92. The proposed
amended rules delete this paragraph because the UB-92 claim
form is no longer in use.
21.2803(c). Required data elements for dental claims. All
amendments to this paragraph are nonsubstantive; they make
minor language, punctuation, and grammatical changes to
make the rule easier to read, understand, and use.
21.2803(d). Coordination of benefits. Subsection (d) has been
divided into three paragraphs to make it easier to read and un-
derstand. It is also amended to incorporate CMS-1500 (02/12)
and to delete obsolete forms CMS-1500 (12/90) and UB-92.
Language has been added to allow for coordination between
this section and any successor rule to existing 28 TAC Chapter
3, Subchapter V, 3.3501 - 3.3511 (Group Coordination of
Benefits), because such a successor rule is now being drafted.
The remaining amendments update internal references, and
make minor language, punctuation, and grammatical changes
to make the rule easier to read, understand, and use.
21.2803(e). Submission of electronic clean claim. The amend-
ments to this subsection make minor language changes to make
the rule easier to read, understand, and use.
21.2803(f). Coordination of benefits on electronic clean claims.
Language has been added to allow for coordination between this
section and any successor rule to existing 28 TAC Chapter 3,
Subchapter V, 3.3501 - 3.3511 (Group Coordination of Bene-
fits), because such a successor rule is now being drafted. The
remaining amendments conform the subchapter to the current
language of the Insurance and Administrative Codes, make mi-
nor language, punctuation, and grammatical changes to make
the rule easier to read, understand, and use.
21.2803(g). Format of elements. Amendments to this subsec-
tion update internal references, and make minor language, punc-tuation, and grammatical changes to conform the subchapter to
the current language of the Insurance and Administrative Codes,
and to make the rule easier to read, understand, and use.
21.2803(h). Additional data elements or information. The one
amendment to this subsection makes a minor language change
to conform the subchapter to the current language of the Insur-
ance and Administrative Codes.
21.2804. Requests for Additional Information from Treating
Preferred Provider. The amendments to this section substitute
the term "managed care carrier" (MCC) for the phrase "HMO or
preferred provider carrier," and make nonsubstantive minor lan-
guage, punctuation, and grammatical changes to conform the
section to the current language of the Insurance and Adminis-
trative Codes, and to make the rule easier to read, understand,
and use.
21.2805. Requests for Additional Information from Other
Sources. The amendments to this section substitute the term
"managed care carrier" (MCC) for the phrase "HMO or preferred
provider carrier," and make nonsubstantive minor language,
punctuation, and grammatical changes to conform the section
to the current language of the Insurance and Administrative
Codes, and to make the rule easier to read, understand, and
use.
21.2806. Claims Filing Deadline. The rule amends the sec-
tion's title to correct its grammar. It adds subsection headings to
conform to the Administrative Code's current custom. The rule
also substitutes the term "managed care carrier" (MCC) for the
phrase "HMO or preferred provider carrier," and makes nonsub-
stantive minor language, punctuation, and grammatical changes
to conform the section to the current language of the Insurance
and Administrative Codes, and to make the rule easier to read,
understand, and use. All other amendments are described be-
low.
21.2806(c) Manner of claim submission. The rule corrects the
subsection by including a method of claim submission listed in
21.2816 that had been omitted.
21.2806(e) Duplicate claims. The proposed rule divides this
subsection into three paragraphs to reflect that prescription ben-
efit claims are subject to different statutory claims payment peri-
ods, and makes nonsubstantive changes to make the subsection
easier to read, understand, and use.
21.2807. Effect of Filing a Clean Claim. The rule amends
this section to substitute the term "managed care carrier" (MCC)
for the phrase "HMO or preferred provider carrier," and makes
nonsubstantive minor language, punctuation, and grammatical
changes to conform the section to the current language of the
Insurance and Administrative Codes, and to make the rule eas-
ier to read, understand, and use. All other amendments are de-
scribed below.
21.2807(c). The proposed rule will eliminate this subsection
about claims for prescription benefits because, as noted in the
Introduction, Insurance Code 843.339 and 1301.104, which
establish the deadlines for action on prescription claims, refer-
ence the date such claims are affirmatively adjudicated, rather
than their receipt as a clean claim.
21.2808. Effect of Filing Deficient Claim. The rule substitutes
the term "managed care carrier" (MCC) for the phrase "HMO
or preferred provider carrier," and makes nonsubstantive minor
language, punctuation, and grammatical changes, including to
the section's title, to conform the section to the current language38 TexReg 8108 November 15, 2013 Texas Register
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Texas. Secretary of State. Texas Register, Volume 38, Number 46, Pages 8023-8312, November 15, 2013, periodical, November 15, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth379973/m1/86/?rotate=0: accessed July 18, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.