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Texas Department of Insurance
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Prompt payment of clean claims

Claims data reporting

TDI issues a mandatory data call for HMOs and preferred provider carriers doing business in Texas per Title 28 of the Texas Administrative Code (TAC) 21.2821.

TDI requires this data call to determine carriers’ compliance with prompt pay requirements on claims submitted by providers under Texas Insurance Code (TIC) 1301.101, TIC 1301.131, TIC 843.336, and TAC 21.2801.

Senate Bill 418 and House Bill 610 prompt pay data call reports are due as follows:

  • First quarter – Due May 15 of each year
  • Second quarter – Due August 15 of each year
  • Third quarter – Due November 15 of each year
  • Fourth quarter – Due February 15 of each year
  • SB 418 annual declinations – Due August 15 of the following year

Clean claims reporting webinar

Report clean claims data on the Prompt payment of clean claims reports portal

Learn more: Webinar showing the features of the portal | Q&A from the webinar

Prompt pay penalty reporting

The Texas Health Insurance Pool dissolved effective September 1, 2015. However House Bill 2064 (passed in 2019) remains in effect. It requires payment of part of the statutory prompt pay penalties to the pool.

TDI has assumed the responsibility for collecting the pool’s share of prompt pay penalties. Insurers and HMOs must continue to file monthly reports and pay the pool’s share of prompt pay penalties to TDI.

Beginning August 2015 and ending for claims paid late in December 2021, all penalty payments and reports were submitted to TDI, on the Prompt Pay Penalty Reporting Form, (FIN593).

Beginning for claims paid late January 2022 and later, all penalty payments and reports should be submitted to TDI. This is indicated in the Payment Information section of the Prompt payment of clean claims reports portal. Reports and penalties should no longer be submitted to the pool.

The pool's portion of prompt pay penalties payable under TIC 843.342 and TIC 1301.137 are as follows, regardless of the type of underlying insurance coverage associated with the late claim payment:

  • Facility Claims: 50% of the entire penalty, including any interest.
  • Non-Facility Claims: The 18% interest portion of the penalty associated with claims paid more than 90 days late.

Claim submission delays due to COVID-19

Providers unable to meet claim submission deadlines due to COVID-19 must tell TDI by email at PromptPay@tdi.texas.gov

See a list of providers and insurers that have notified TDI that their claim submissions will be delayed

Related links

For more information, contact: PromptPay@tdi.texas.gov

Last updated: 9/26/2022