Prompt Pay in Texas

Posted by on Jul 2, 2015 in Prompt Pay

In 2003, Texas passed legislation to help doctors receive compensation from insurance companies in a timely manner to help them continue with their day-to-day business practices. Qualifying medical care providers may be eligible to file claims against insurance companies who have denied them timely payments. According to a the website of Williams Kherkher, medical practices which are not compensated by insurance agencies are, in fact, entitled to fair compensation through a legal suit, thanks to the Texas Prompt Pay Act.

Why would doctors file a claim?

After a doctor performs a service for their patient, the patient pays by providing their insurance information. Doctors then file claims with the insurance provider for compensation for their services. In a perfect world, the repayment is provided by insurance companies in a timely manner (within 45 days of a non-electronic submission of a claim, within 30 days of an electronic submission). However, this is not always the case.

There are some provisions that medical practices must meet tin order to be eligible to recover funds. There must be an existing contract between the doctor and insurance provider. Only insurance plans such as health maintenance organizations, or HMOs and preferred provider organizations, or PPOs, are obligated to repay doctors fully under the Texas Prompt Pay Act, or face litigation. Medicare, Medicaid, government, school plans and the like are not held liable under the act.

Although the Texas Prompt Pay Act is designed to protect medical practices, it is quite common to hire a lawyer to oversee the process of recovering payment from insurance companies.

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