(a) An MCC, a physician, or a provider must notify the Texas Department of Insurance (TDI) if, due to a catastrophic event, it is unable to meet the deadlines in §21.2804 of this title (relating to Requests for Additional Information from Treating Preferred Provider), §21.2806 of this title (relating to Claims Filing Deadline), §21.2807 of this title (relating to Effect of Filing a Clean Claim), §21.2808 of this title (relating to Effect of Filing Deficient Claim), §21.2809 of this title (relating to Audit Procedures), and §21.2815 of this title (relating to Failure to Meet the Statutory Claims Payment Period), as applicable. The entity must send a request required under this section to TDI within five days of the date the catastrophic event began substantially interfering with the normal business operations of the entity, or as specified in a notice published by the commissioner regarding the catastrophic event.
(b) An entity must send the request required under this section to TDI by email to PromptPay@tdi.texas.gov, unless an alternative electronic method is provided by TDI for a specified event. The request must:
  (1) be from:
    (A) if for a physician or a provider, the physician, provider, office manager, administrator, or their designee; or
    (B) if for an MCC, a corporate officer or a corporate officer's designee;
  (2) identify the specific nature of the catastrophic event;
  (3) identify the first date the catastrophic event caused an interruption in the claims submission or processing activities of the physician, provider, or MCC;
  (4) identify the date the physician, provider, or MCC reasonably expects to resume normal business operations;
  (5) state how the catastrophic event is substantially interfering with the entity's normal business operations;
  (6) include the contact information for the physician, provider, or MCC, including each entity's name, email address, phone number, and:
    (A) if for a physician or provider, the national provider identification number; or
    (B) if for an MCC, the entity's NAIC number; and
  (7) include the physical address of each business or practice location affected by the catastrophic event.
(c) A request under this section tolls the applicable deadlines in §§21.2804, 21.2806, 21.2807, 21.2808, 21.2809, and 21.2815 of this title for the number of days between the date identified in subsection (b)(3) of this section and the earlier of any date specified in a notice published by the commissioner or listed in TDI's approval of a request, or the date the entity is able to resume normal business operations.
(d) If a catastrophic event is expected to continue to substantially interfere with an entity's normal business operations past the date in a notice published by the commissioner or in TDI's approval of an extension request, then the entity must send an additional request meeting the requirements of this section to TDI at least three business days before the expiration of the existing extension. The new request must explain why an additional extension is needed. If an entity resumes normal business operations sooner than the date the extension would otherwise expire, the entity must send a notification to TDI of the date the entity resumed normal business operations, no later than three business days after that date.
(e) TDI will contact the physician, provider, or MCC if more information is needed for any request received. TDI may disapprove a request if the nature of the event does not meet the definition of a catastrophic event that substantially interferes with the entity's normal business operations. TDI may limit a requested extension if the identified duration of interruption to normal business operations is not proportional to the nature of the catastrophic event.

Source Note: The provisions of this §21.2819 adopted to be effective October 5, 2003, 28 TexReg 8647; amended to be effective February 16, 2014, 39 TexReg 747; amended to be effective November 7, 2021, 46 TexReg 7408; amended to be effective March 18, 2024, 49 TexReg 1720