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A BILL TO BE ENTITLED
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AN ACT
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relating to the timely submission of a claim for payment by a |
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workers' compensation health care provider. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 408, Labor Code, is |
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amended by adding Section 408.0272 to read as follows: |
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Sec. 408.0272. CERTAIN EXCEPTIONS FOR UNTIMELY SUBMISSION |
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OF CLAIM. (a) In this section: |
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(1) "Group accident and health insurance" has the |
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meaning assigned by Chapter 1251, Insurance Code. |
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(2) "Health maintenance organization" has the meaning |
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assigned by Chapter 843, Insurance Code. |
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(b) Notwithstanding Section 408.027, a health care provider |
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who fails to timely submit a claim for payment to the insurance |
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carrier under Section 408.027(a) does not forfeit the provider's |
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right to reimbursement for that claim for payment solely for |
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failure to submit a timely claim if: |
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(1) the provider submits proof satisfactory to the |
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commissioner that the provider, within the period prescribed by |
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Section 408.027(a), erroneously filed for reimbursement with: |
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(A) an insurer that issues a policy of group |
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accident and health insurance under which the injured employee is a |
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covered insured; |
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(B) a health maintenance organization that |
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issues an evidence of coverage under which the injured employee is a |
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covered enrollee; or |
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(C) a workers' compensation insurance carrier |
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other than the insurance carrier liable for the payment of benefits |
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under this title; or |
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(2) the commissioner determines that the failure |
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resulted from a catastrophic event that substantially interfered |
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with the normal business operations of the provider. |
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(c) Notwithstanding Subsection (b), a health care provider |
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who erroneously submits a claim for payment to an entity described |
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by Subdivision (1) of that subsection forfeits the provider's right |
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to reimbursement for that claim if the provider fails to submit the |
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claim to the correct workers' compensation insurance carrier within |
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95 days after the date the provider is notified of the provider's |
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erroneous submission of the claim. |
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(d) Notwithstanding any other provision of this section or |
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Section 408.027, the period for submitting a claim for payment may |
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be extended by agreement of the parties. |
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SECTION 2. Section 408.0272, Labor Code, as added by this |
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Act, applies to a claim for payment relating to health care services |
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rendered on or after the effective date of this Act. A claim for |
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payment relating to health care services rendered before the |
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effective date of this Act is governed by the law in effect |
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immediately before the effective date of this Act, and the former |
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law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2007. |