Incident-to Billing Guide - Provides the incident-to billing guidelines for various payers.
Texas Prompt Pay Law (fully insured plans) - On June 17, 2003, Governor Perry signed into law SB 418 also known as Texas Prompt Pay to help physicians receive payment for services promptly. Plans that are regulated by this law will have "TDI" or "DOI" printed on the front or back of the member's insurance card.The Texas Department of Insurance (TDI) provider website has Tips and FAQ's on prompt pay laws and instructions for filing complaints via paper or online for providers and consumers to file complaints against payers who violate provisions of SB 418.
Texas Expedited Credentialing (fully insured plans and Medicaid Managed Care plans) - If you have an established group contract with a commercial or Medicaid Managed Care plan and you have a new physician joining the group contract, upon submission of all the appropriate credentialing information to the payer, for payment purposes only until credentialing is approved, the commercial payer shall treat the applicant physician as if the physician were a participating provider in the health benefit plan network when the applicant physician provides services to the managed care plan's enrollees. Also, if a commercial payer is using a third party entity for credentialing purposes, the third party is also subject to the same requirements that the commercial payer is subject to for credentialing purposes. It is recommended that any notification from the plan that the application has been accepted and all documents needed to credential have been received be kept as the date of that notification is the date that the applicant can begin seeing the plan's enrollees as an in-network provider while their application is in process. If the physician is not credentialed, all claims paid as in-network will be reprocessed as out-of-network and refunds of over-payments will be required.
Retroactive Termination (fully insured plans) - Senate Bill 51 prohibits retro-terminations and requires that an employer is required to provide coverage under the policy until the end of the month in which the employer notifies the insurer of termination of the employee's benefits. However, if the termination of employment occurs in the last seven days of the month, the employer has three business days into the next month to notify the carrier of the termination and thus avoid paying the additional premium for that month. An exception to this law applies to any former employee already enrolled in some form of continuation of coverage, such as Texas State Continuation, COBRA, or USERRA.
* Texas HB 574 - An act regarding out-of-network disclosures that took effect Sept. 1, 2015. This act provides information regarding access to out of network physicians/providers/facilities disclosure forms.