Texas Senate Bill SB843

Texas 2015 - 84th Regular

Caption

Relating to prompt payment of health care claims, including payment for immunizations, vaccines, and serums.

Impact

The bill introduces significant changes to the existing claims process by stipulating that if an HMO fails to determine or adjudicate a clean claim by the mandated deadline, it must pay the provider not only the owed amount but also a penalty. These penalties are structured to incentivize timely payment, with amounts escalating based on how overdue the payments are. Additionally, the legislation specifies that claims should be submitted within a specific timeframe after services are provided, and that appeal deadlines for disputed payments should be extended to provide providers with ample opportunity to challenge decisions.

Summary

Senate Bill 843 seeks to enhance the prompt payment of health care claims, primarily addressing payments for immunizations, vaccines, and serums. This legislation amends various sections of the Insurance Code, establishing clearer guidelines and deadlines for health maintenance organizations (HMOs) and insurers regarding the payment of claims submitted by healthcare providers. It aims to ensure that claims are processed in a timely manner, thereby reducing the financial strain on healthcare providers and improving the overall healthcare delivery system.

Contention

While proponents argue that SB843 will protect healthcare providers from delayed payments and promote a more effective healthcare system, there are concerns regarding the enforcement and implications of these penalties. Critics worry that strict penalties may result in unintended consequences, such as heightened administrative burdens on HMOs and insurers, or increased costs that could lead to higher insurance premiums for consumers. Furthermore, ensuring compliance from various stakeholders within the healthcare industry remains a significant challenge as the bill is implemented.