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Prompt Payment of Clean Claims

Claims Data Reporting

Pursuant to Title 28 Texas Administrative Code (TAC) Section 21.2821, the Texas Department of Insurance (TDI) issues a mandatory data call for HMOs and preferred provider carriers doing business in Texas (collectively “carriers”).

TDI requires this data call to determine carriers’ compliance with prompt pay requirements on claims submitted by providers under Texas Insurance Code (TIC) Chapter 1301, Subchapters C and C-1; TIC Chapter 843, Subchapter J; and 28 TAC Chapter 21, Subchapter T.

SB418/HB610 prompt pay data call reports are due as follows:

  • First quarter – Due May 15th of each year
  • Second quarter – Due August 15th of each year
  • Third quarter – Due November 15th of each year
  • Fourth quarter – Due February 15th of each year
  • SB418 Annual Declinations – Due August 15th of the following year

The online claims data reporting application and forms are available on the TDI website at https://apps.tdi.state.tx.us/SB418company/Login.do.

A tips guide with detailed additional information on reporting is available at www.tdi.texas.gov/hprovider/documents/provclaimstips.pdf.

Prompt Pay Penalty Reporting

The Texas Health Insurance Pool dissolved effective September 1, 2015. However HB 2064 (81R), which requires payment of part of the statutory prompt pay penalties to the Pool, remains in effect. 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, all penalty payments and reports should be submitted to TDI, as indicated on the Prompt Pay Penalty Reporting Form, (TDI form FIN593). 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 1301.137 are as follows, regardless of the type of underlying insurance coverage associated with the late claim payment:

1) Facility Claims: 50% of the entire penalty, including any interest.

2) Non-Facility Claims: The 18% interest portion of the penalty associated with claims paid more than 90 days late.

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Last updated: 02/19/2017

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