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A BILL TO BE ENTITLED
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AN ACT
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relating to notice of inaccurate payment or nonpayment of certain |
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claims under certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter C, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.110 to read as follows: |
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Sec. 1301.110. NOTICE OF NONPAYMENT OR INACCURATE PAYMENT |
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OF CLAIM FROM PREFERRED PROVIDER. (a) A preferred provider that |
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asserts that a claim for medical care or health care services, |
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including a claim for payment of the amount due for any disallowed |
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discount on the service or supply provided or any additional |
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payment due after the completion of an audit under this subchapter, |
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has not been timely or accurately paid shall, not later than the |
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180th day after the earlier of the date the preferred provider |
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received payment or the date that payment was due, provide written |
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notification of the nonpayment or inaccuracy to the insurer or the |
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person with whom the insurer contracts to process or pay claims, if |
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any, or, in the case of a self-funded or self-insured employee |
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benefit plan, to the employer or the person with whom the employer |
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contracts to process or pay claims, if any. |
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(b) If the preferred provider or the preferred provider's |
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agent or assignee fails to provide the notification required by |
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this section before the 180th day, the preferred provider, agent, |
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or assignee is barred from asserting the claim of nonpayment or |
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inaccuracy. |
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(c) The notification required by this section does not |
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affect any deadline for filing a claim or for instituting any cause |
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of action based on the payment or nonpayment of a claim. |
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SECTION 2. This Act applies only to a claim made under a |
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health insurance policy or self-funded or self-insured employee |
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welfare benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2014. A claim made under a health |
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insurance policy or self-funded or self-insured employee welfare |
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benefit plan delivered, issued for delivery, or renewed before |
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January 1, 2014, is governed by the law as it existed immediately |
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before the effective date of this Act, and that law is continued in |
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effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2013. |