Bill Text: TX HB3773 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to claims submitted and requests for verification made by a physician or health care provider to certain health benefit plan issuers and administrators.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-03-20 - Referred to Insurance [HB3773 Detail]
Download: Texas-2023-HB3773-Introduced.html
88R11672 CJD-D | ||
By: Johnson of Dallas | H.B. No. 3773 |
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relating to claims submitted and requests for verification made by | ||
a physician or health care provider to certain health benefit plan | ||
issuers and administrators. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 843.3385, Insurance Code, is amended by | ||
adding Subsection (g) to read as follows: | ||
(g) A health maintenance organization shall accept relevant | ||
clinical records submitted by a treating physician or provider with | ||
a claim related to the records or at any time after submission of | ||
the claim. | ||
SECTION 2. Section 843.342, Insurance Code, is amended by | ||
adding Subsection (o) to read as follows: | ||
(o) For the purposes of calculating a penalty under this | ||
section related to a claim by a physician or provider described by | ||
Section 843.351, the contracted rate for health care services | ||
provided by the physician or provider is the usual and customary | ||
rate for the service in the geographic area in which the service is | ||
provided. | ||
SECTION 3. Section 843.351, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 843.351. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND | ||
PROVIDERS. The provisions of this subchapter relating to prompt | ||
payment by a health maintenance organization of a physician or | ||
provider and to verification of health care services apply to a | ||
physician or provider who: | ||
(1) is not included in the health maintenance | ||
organization delivery network; and | ||
(2) provides health care services to an enrollee[ |
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SECTION 4. Section 1301.069, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1301.069. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND | ||
HEALTH CARE PROVIDERS. The provisions of this chapter relating to | ||
prompt payment by an insurer of a physician or health care provider | ||
and to verification of medical care or health care services apply to | ||
a physician or provider who: | ||
(1) is not a preferred provider included in the | ||
preferred provider network; and | ||
(2) provides health care services to an insured[ |
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SECTION 5. Section 1301.1054, Insurance Code, is amended by | ||
adding Subsection (f) to read as follows: | ||
(f) An insurer shall accept relevant clinical records | ||
submitted by a treating physician or provider with a claim related | ||
to the records or at any time after submission of the claim. | ||
SECTION 6. Section 1301.137, Insurance Code, is amended by | ||
adding Subsection (m) to read as follows: | ||
(m) For the purposes of calculating a penalty under this | ||
section related to a claim by a physician or health care provider | ||
described by Section 1301.069, the contracted rate for health care | ||
services provided by the physician or provider is the usual and | ||
customary rate for the service in the geographic area in which the | ||
service is provided. | ||
SECTION 7. Subchapter E, Chapter 1551, Insurance Code, is | ||
amended by adding Section 1551.231 to read as follows: | ||
Sec. 1551.231. ACCEPTANCE OF CLINICAL RECORDS. The | ||
administrator of a managed care plan provided under the group | ||
benefits program shall accept relevant clinical records submitted | ||
by a treating physician or provider with a claim related to the | ||
records or at any time after submission of the claim. | ||
SECTION 8. Subchapter D, Chapter 1575, Insurance Code, is | ||
amended by adding Section 1575.174 to read as follows: | ||
Sec. 1575.174. ACCEPTANCE OF CLINICAL RECORDS. The | ||
administrator of a managed care plan provided under the group | ||
program shall accept relevant clinical records submitted by a | ||
treating physician or provider with a claim related to the records | ||
or at any time after submission of the claim. | ||
SECTION 9. Subchapter C, Chapter 1579, Insurance Code, is | ||
amended by adding Section 1579.112 to read as follows: | ||
Sec. 1579.112. ACCEPTANCE OF CLINICAL RECORDS. The | ||
administrator of a managed care plan provided under this chapter | ||
shall accept relevant clinical records submitted by a treating | ||
physician or provider with a claim related to the records or at any | ||
time after submission of the claim. | ||
SECTION 10. Subchapter D, Chapter 1601, Insurance Code, is | ||
amended by adding Section 1601.156 to read as follows: | ||
Sec. 1601.156. ACCEPTANCE OF CLINICAL RECORDS. The | ||
administering carrier of a managed care plan provided under this | ||
chapter shall accept relevant clinical records submitted by a | ||
treating physician or provider with a claim related to the records | ||
or at any time after submission of the claim. | ||
SECTION 11. (a) Sections 843.342(o) and 1301.137(m), | ||
Insurance Code, as added by this Act, apply only to a penalty or | ||
interest on a penalty owed with respect to a claim submitted on or | ||
after the effective date of this Act. | ||
(b) Sections 843.351 and 1301.069, Insurance Code, as | ||
amended by this Act, apply only to health care services provided and | ||
verification requests made on or after the effective date of this | ||
Act. Health care services provided and verification requests made | ||
before the effective date of this Act are 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 12. This Act takes effect September 1, 2023. |