83R3025 TJS-D
By: Deuell S.B. No. 257
A BILL TO BE ENTITLED
AN ACT
relating to notice of inaccurate payment or nonpayment of certain
claims under certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter C, Chapter 1301, Insurance Code, is
amended by adding Section 1301.110 to read as follows:
Sec. 1301.110. NOTICE OF NONPAYMENT OR INACCURATE PAYMENT
OF CLAIM FROM PREFERRED PROVIDER. (a) A preferred provider that
asserts that a claim for medical care or health care services,
including a claim for payment of the amount due for any disallowed
discount on the service or supply provided or any additional
payment due after the completion of an audit under this subchapter,
has not been timely or accurately paid shall, not later than the
180th day after the earlier of the date the preferred provider
received payment or the date that payment was due, provide written
notification of the nonpayment or inaccuracy to the insurer or the
person with whom the insurer contracts to process or pay claims, if
any, or, in the case of a self-funded or self-insured employee
benefit plan, to the employer or the person with whom the employer
contracts to process or pay claims, if any.
(b) If the preferred provider or the preferred provider's
agent or assignee fails to provide the notification required by
this section before the 180th day, the preferred provider, agent,
or assignee is barred from asserting the claim of nonpayment or
inaccuracy.
(c) The notification required by this section does not
affect any deadline for filing a claim or for instituting any cause
of action based on the payment or nonpayment of a claim.
SECTION 2. This Act applies only to a claim made under a
health insurance policy or self-funded or self-insured employee
welfare benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2014. A claim made under a health
insurance policy or self-funded or self-insured employee welfare
benefit plan delivered, issued for delivery, or renewed before
January 1, 2014, is governed by the law as it existed immediately
before the effective date of this Act, and that law is continued in
effect for that purpose.
SECTION 3. This Act takes effect September 1, 2013.