By Turner of Harris H.B. No. 1903 77R4401 AJA-F A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to verification of coverage by a preferred provider 1-3 benefit plan or a health maintenance organization. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Article 3.70-3C, Insurance Code, as added by 1-6 Chapter 1024, Acts of the 75th Legislature, Regular Session, 1997, 1-7 is amended by adding Section 3C to read as follows: 1-8 Sec. 3C. VERIFICATION OF COVERAGE. An insurer shall inform 1-9 a preferred provider of whether or not an insured is covered for a 1-10 service or benefit if the preferred provider requests the 1-11 information before providing the service or benefit to the insured. 1-12 If an insurer verifies that an insured is covered for a service or 1-13 benefit, the insurer may not deny payment for the service or 1-14 benefit unless a written notice of an error in the verification is 1-15 received by the preferred provider before the service or benefit is 1-16 provided. 1-17 SECTION 2. The Texas Health Maintenance Organization Act 1-18 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding 1-19 Section 18E to read as follows: 1-20 Sec. 18E. VERIFICATION OF COVERAGE. A health maintenance 1-21 organization shall inform a physician or provider of whether or not 1-22 an enrollee is covered for a service or benefit if the physician or 1-23 provider requests the information before providing the service or 1-24 benefit to the enrollee. If a health maintenance organization 2-1 verifies that an enrollee is covered for a service or benefit, the 2-2 health maintenance organization may not deny payment for the 2-3 service or benefit unless a written notice of an error in the 2-4 verification is received by the physician or provider before the 2-5 service or benefit is provided. 2-6 SECTION 3. This Act takes effect September 1, 2001.