6 TIC §843.342(a-b)
August 8, 2021 1:19 am(a) …the health maintenance organization shall pay the physician or provider making the claim the contracted rate owed on the... View more
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6 TIC §843.338
August 8, 2021 1:09 amExcept as provided by Sections 843.3385 and 843.339, not later than the 45th day after the date on which a... View more
Texas Department of Insurance
May 5, 2021 7:37 pmNew York Department of Financial Services
May 5, 2021 7:34 pmFlorida Department of Financial Services
May 5, 2021 7:31 pmTX HMO Script – Untimely Payment
May 5, 2021 5:39 pmASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
TX HMO Script – Retroactive Denial for Authorized Care
May 5, 2021 5:34 pmASK YOURSELF: Was the coverage terminated? Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation... View more
TX HMO Script – Refund Recoupment
May 5, 2021 5:29 pmASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
TX HMO Script – Poststabilization Timeframe
May 5, 2021 5:17 pmASK YOURSELF: When was the patient stabilized in the emergency room or admitted as an inpatient? Was it during normal... View more
TX HMO Script – Notice Requirements for Adverse Determinations
May 5, 2021 4:52 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more