State Law

Texas Statutes-Insurance Code-Title 8-Subtitle D-Chapter 1301- Subchapter C. Prompt Payment of Claims

08/24/2023 Texas Section 1301.106

Claims Processing Procedures and Claims Payment Processes

Payment Edits

(a) An insurer shall provide a preferred provider with copies of all applicable utilization review policies and claim processing policies or procedures.

(b) An insurer’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.