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Texas Insurance Code - INS § 843.341. Claims Processing Procedures

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) A health maintenance organization shall provide a participating physician or provider with copies of all applicable utilization review policies and claim processing policies or procedures.

(b) A health maintenance organization's claims payment processes shall:

(1) use nationally recognized, generally accepted Current Procedural Terminology codes, notes, and guidelines, including all relevant modifiers;  and

(2) be consistent with nationally recognized, generally accepted bundling edits and logic.

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 843.341. Claims Processing Procedures - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-843-341/

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