Sec. 1301.106. CLAIMS PROCESSING PROCEDURES AND CLAIMS PAYMENT PROCESSES. (a) An insurer shall provide a preferred provider with copies of all applicable utilization review policies and claim processing policies or procedures.
(b) An insurer's claims payment processes shall:
(1) use nationally recognized, generally accepted Current Procedural Terminology codes, notes, and guidelines, including all relevant modifiers; and
(2) be consistent with nationally recognized, generally accepted bundling edits and logic.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.037(a), eff. September 1, 2005.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1301 - Preferred Provider Benefit Plans
Subchapter C. Prompt Payment of Claims
Section 1301.102. Submission of Claim
Section 1301.1021. Receipt of Claim
Section 1301.103. Deadline for Action on Clean Claims
Section 1301.104. Deadline for Action on Pharmacy Claims; Payment
Section 1301.105. Audited Claims
Section 1301.1051. Completion of Audit
Section 1301.1052. Preferred Provider Appeal After Audit
Section 1301.1053. Deadlines Not Extended
Section 1301.1054. Requests for Additional Information
Section 1301.106. Claims Processing Procedures and Claims Payment Processes
Section 1301.107. Contractual Waiver and Other Actions Prohibited
Section 1301.108. Attorney's Fees
Section 1301.109. Applicability to Entities Contracting With Insurer