By Smithee H.B. No. 2826
77R7901 MXM-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the adoption of a uniform explanation of payment form
1-3 by the Texas Department of Insurance.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 21.52C, Insurance Code, is amended to
1-6 read as follows:
1-7 Art. 21.52C. UNIFORM CLAIM BILLING AND PAYMENT FORMS.
1-8 Sec. 1. DEFINITIONS. [(a)] In this article:
1-9 (1) "Health benefit plan" means a group, blanket, or
1-10 franchise insurance policy, a group hospital service contract, or a
1-11 group subscriber contract or evidence of coverage issued by a
1-12 health maintenance organization that provides benefits for health
1-13 care services.
1-14 (2) "Health carrier" means any entity authorized under
1-15 this code or another insurance law of this state that provides
1-16 health insurance or health benefits in this state, including an
1-17 insurance company, a group hospital service corporation under
1-18 Chapter 20 of this code, a health maintenance organization under
1-19 the Texas Health Maintenance Organization Act (Chapter 20A,
1-20 Vernon's Texas Insurance Code), and a stipulated premium company
1-21 authorized under Chapter 22 of this code.
1-22 (3) "Provider" means an individual or entity [a
1-23 person] who provides health care under a license issued by this
1-24 state, including an individual or entity described under:
2-1 (A) [a person listed in] Section 2(B), Chapter
2-2 397, Acts of the 54th Legislature, Regular Session, 1955 (Article
2-3 3.70-2, Vernon's Texas Insurance Code);
2-4 (B) Article 3.70-3C of this code, as added by
2-5 Chapter 1024, Acts of the 75th Legislature, Regular Session,
2-6 1997;[,] or
2-7 (C) [in] Article 21.52 of this code.
2-8 Sec. 2. USE OF UNIFORM CLAIM BILLING FORM REQUIRED. [(b)] A
2-9 provider seeking payment or reimbursement under a health benefit
2-10 plan and the health carrier that issued that plan must use uniform
2-11 claim billing form UB-82/HCFA or HCFA 1500, or their successors, as
2-12 developed by the National Uniform Billing Committee or its
2-13 successor.
2-14 Sec. 3. USE OF UNIFORM EXPLANATION OF PAYMENT FORM REQUIRED.
2-15 (a) The commissioner by rule shall adopt a single uniform
2-16 explanation of payment form and by rule shall define the
2-17 terminology used in that form.
2-18 (b) Each health carrier shall use the uniform explanation of
2-19 payment form adopted under this section and shall send that form to
2-20 a provider with any payment for a claim. The form must contain
2-21 the information necessary for the provider to be able to determine
2-22 if the amount of the payment made is correct. If there is a
2-23 contract between the health carrier and the provider, the form must
2-24 also contain any information necessary for the provider to
2-25 determine if the amount of payment is correct according to the
2-26 terms of the contract.
2-27 (c) A health carrier shall send the uniform explanation of
3-1 payment form to a provider in the same manner required for
3-2 transmission of the claim payment, either through an electronic
3-3 format that complies with applicable federal law or regulations, or
3-4 through a paper format.
3-5 SECTION 2. (a) Except as provided by Subsection (b) of this
3-6 section, this Act takes effect September 1, 2001, and applies only
3-7 to a claim under a health benefit plan that is filed with a health
3-8 carrier on or after January 1, 2002. A claim filed before January
3-9 1, 2002, is governed by the law in effect on the date that the
3-10 claim was filed, and the former law is continued in effect for that
3-11 purpose.
3-12 (b) The commissioner of insurance shall adopt rules as
3-13 required by Article 21.52C, Insurance Code, as amended by this Act,
3-14 not later than December 1, 2001.