Sec. 843.346. PAYMENT OF CLAIMS. Except as provided by this subchapter, a health maintenance organization shall pay a physician or provider for health care services and benefits provided to an enrollee not later than:
(1) the 45th day after the date on which a claim for payment is received with the documentation reasonably necessary to process the claim; or
(2) if applicable, within the number of calendar days specified by written agreement between the physician or provider and the health maintenance organization.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003. Amended by Acts 2003, 78th Leg., ch. 214, Sec. 18, eff. June 17, 2003.
Structure Texas Statutes
Title 6 - Organization of Insurers and Related Entities
Subtitle C - Life, Health, and Accident Insurers and Related Entities
Chapter 843 - Health Maintenance Organizations
Subchapter J. Payment of Claims to Physicians and Providers
Section 843.337. Time for Submission of Claim; Duplicate Claims; Acknowledgment of Receipt of Claim
Section 843.338. Deadline for Action on Clean Claims
Section 843.3385. Additional Information
Section 843.339. Deadline for Action on Prescription Claims; Payment
Section 843.340. Audited Claims
Section 843.3405. Investigation and Determination of Payment
Section 843.341. Claims Processing Procedures
Section 843.342. Violation of Certain Claims Payment Provisions; Penalties
Section 843.343. Attorney's Fees
Section 843.346. Payment of Claims
Section 843.348. Preauthorization of Health Care Services
Section 843.3481. Posting of Preauthorization Requirements
Section 843.3483. Remedy for Noncompliance
Section 843.349. Coordination of Payment
Section 843.351. Services Provided by Certain Physicians and Providers
Section 843.352. Conflict With Other Law