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You are here: www.tdi.texas.gov . hprovider . ppguidelines

Prompt Pay Guidelines

In Texas, physicians and providers are entitled to prompt payment for medical and health care services. Senate Bill 418 (78th Regular Legislative Session - 2003) and House Bill 610 (76th Legislative Session - 1999) detail specific provisions that require certain insurance carriers and health maintenance organizations to pay clean claims timely. Each statute has payment deadlines to ensure prompt payment of clean claims. To determine whether the medical or health care services are subject to prompt payment provisions, review the following questions:

1. Are the services I provided covered under an HMO or insured PPO plan?

Yes: Go to 2.
No: Your services are not subject to Texas' prompt pay requirements.

2. Do I have a contract with an HMO or a PPO?

Yes: Your services may be subject to the prompt pay requirements. Go to 3 to determine which requirements may apply.
No: Go to 4.

3. Was my contract entered or last renewed on or after August 16, 2003?

Yes: Your services would come under the provisions of SB418 and related rules.
No: Your services would come under the provisions of HB610 and related rules for claims with a date of service on or after August 1, 2000.

4. Did I provide, on or after August 16, 2003, (a) services on referral from an HMO, PPO, or a preferred provider because the services were not reasonably available in-network or (b) emergency care services?

Yes: Your services would come under the provisions of SB418 and related rules.
No: Your services are not subject to Texas' prompt pay requirements.

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Last updated: 09/06/2014

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Translation by WorldLingo