Texas Insurance Code

§ 843.341 — CLAIMS PROCESSING PROCEDURES

IN § 843.341Title 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES · Part C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES · Ch. 843. HEALTH MAINTENANCE ORGANIZATIONS · Art. J. PAYMENT OF CLAIMS TO PHYSICIANS AND PROVIDERS

Statute text

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(a)A health maintenance organization shall provide a participating physician or provider with copies of all applicable utilization review policies and claim processing policies or procedures.

(b)A health maintenance organization'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.

Legislative history

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003. Amended by Acts 2003, 78th Leg., ch. 214, Sec. 13, eff. June 17, 2003.