This website will be unavailable from Friday, April 26, 2024 at 6:00 p.m. through Monday, April 29, 2024 at 7:00 a.m. due to data center maintenance.

                                                                                

78R2886 AKH-D

By:  Nelson                                                       S.B. No. 1846



A BILL TO BE ENTITLED

AN ACT

relating to the prompt payment of certain claims by health 
maintenance organizations and preferred provider benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 3A(d), Article 3.70-3C, Insurance Code, 
as added by Chapter 1024, Acts of the 75th Legislature, Regular 
Session, 1997, is amended to read as follows:
	(d)  Not [If a prescription benefit claim is electronically 
adjudicated and electronically paid, and the preferred provider or 
its designated agent authorizes treatment, the claim must be paid 
not] later than the 21st day after the date an insurer affirmatively 
adjudicates a pharmacy claim that is electronically submitted, the 
insurer shall:
		(1)  pay the total amount of the claim through 
electronic funds transfer; or
		(2)  notify the pharmacy provider of the reasons for 
denying payment of the claim [treatment is authorized].
	SECTION 2.  Section 843.339, Insurance Code, as effective 
June 1, 2003, is amended to read as follows:
	Sec. 843.339.  DEADLINE FOR ACTION ON CERTAIN PRESCRIPTION 
BENEFIT CLAIMS.  Not [If a health maintenance organization or its 
designated agent authorizes treatment, a prescription benefit 
claim that is electronically adjudicated and electronically paid 
shall be paid not] later than the 21st day after the date a health 
maintenance organization or the health maintenance organization's 
designated agent affirmatively adjudicates a pharmacy claim that is 
electronically submitted, the health maintenance organization 
shall:
		(1)  pay the total amount of the claim through 
electronic funds transfer; or
		(2)  notify the pharmacy provider of the reasons for 
denying payment of the claim [on which the treatment is 
authorized].
	SECTION 3.  This Act takes effect September 1, 2003, and 
applies only to a payment to a pharmacy provider for claims 
submitted to a health maintenance organization or an insurer on or 
after that date.