Physicians and health care providers must submit claims to insurers within 95 days after services are provided, and they may use mail, electronic, fax, or hand delivery methods unless Chapter 1213 applies.
Sec. 1301.102. SUBMISSION OF CLAIM. (a) A physician or health care provider must submit a claim to an insurer not later than the 95th day after the date the physician or provider provides the medical care or health care services for which the claim is made. (b) Except as provided by Chapter 1213, a physician or health care provider may, as appropriate: (1) mail a claim by United States mail, first class, or by overnight delivery service; (2) submit the claim electronically; (3) fax the claim; or (4) hand deliver the claim. (c) An insurer shall accept as proof of timely filing a claim filed in compliance with Subsection (b) or information from another insurer or health maintenance organization showing that the physician or health care provider submitted the claim to the insurer or health maintenance organization in compliance with Subsection (b). (d) If a physician or health care provider fails to submit a claim in compliance with this section, the physician or provider forfeits the right to payment. (e) The period for submitting a claim under this section may be extended by: (1) contract; (2) notice published by the commissioner allowing an extension of prompt payment deadlines to a later date chosen by the commissioner due to a catastrophic event; or (3) the department's approval of a physician's or health care provider's request for an extension due to a catastrophic event that substantially interferes with the normal business operations of the physician or provider. (e-1) The commissioner may adopt rules to implement Subsection (e), including rules establishing requirements for a request made under Subsection (e)(3). (f) A physician or health care provider may not submit a duplicate claim for payment before the 46th day after the date the original claim was submitted. The commissioner shall adopt rules under which an insurer may determine whether a claim is a duplicate claim. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.037(a), eff. September 1, 2005. Acts 2023, 88th Leg., R.S., Ch. 90 (S.B. 1286), Sec. 3, eff. September 1, 2023.