Texas Prompt Pay Statutes

AN OVERVIEW OF THE TEXAS PROMPT PAY STATUTES:

HOUSE BILL 610: 

1. Applies to services performed after August 1, 2000. 
2. Key Provisions: 
   1. Must pay claims in 45 days for non-electronic and 30 days for electronic. 
   2. Clean Claims must be complete, legible, and accurate. 
   3. Audits/ Overpayments must be determined in 180 days and there is no deadline for refund
      requests.

SENATE BILL 418: 

1. Applies to contracts that were renewed and services provided after October 5, 2003. 
2. Applies to Contracted HMO’s, Contracted PPO’s, Non-contracted carriers that provide specialtyservices based on a referral, and emergency care services. 
3. Does not apply to Self Funded ERISA plans, Workers Comp Claims, Out of State Insureds, Medicaid/ Medicare, Government Plans, School Plans, Church Plans, CHIP, CHAMPUS, and Health Select Plans. 
4. Key Provisions: 
   1. Verification is a Guarantee of Payment. 
   2. If a pre-authorization is based on medical necessity the claim cannot be denied. 
   3. Coordination of Benefits is no longer an excuse to delay payment. 
   4. Clean claims must be complete, legible and accurate and electronic claims must be HIPAA compliant.
   5. The filing deadline for providers is 95 days. 
   6. Must pay claims in 45 days for non-electronic and 30 days for electronic. 
   7. Audits/ Overpayments must be determined in 180 days and there is a deadline for requesting
      refunds.

Call us today for more information on how we can assist you prompt pay issues.