texas 6796059 640

Compliance Corner: Texas Insurance Carriers & Incomplete Medical Bills

15 Mar, 2024 Frank Ferreri

texas 6796059 640

Austin, TX (WorkersCompensation.com) -- A Texas rule requires carriers to evaluate medical bills for completeness. Here's a rundown on what the state wants to see from carriers.

Insurance carriers must not return medical bills that are complete, unless the bill is a duplicate bill, but if a bill is incomplete, there are steps the carrier must take.

Within 30 days after the day it receives a medical bill that is not complete, an insurance carrier must:

(1) Complete the bill by adding missing information already known to the insurance carrier, except for the following:

--> Dates of service;
--> Procedure or modifier codes;
--> Number of units; and
--> Charges; or

(2) Return the bill to the sender.

Get filled in on Texas and the rest of the U.S. with Simply Research

The insurance carrier may contact the sender to get the information necessary to make the bill complete. If the insurance carrier gets the missing information and completes the bill, the insurance carrier must document the name and telephone number of the person who supplied the information.

When returning a medical bill, the insurance carrier must include a document identifying the reasons for returning the bill. The reasons related to the procedure or modifier codes must identify the reasons by line item.

The proper return of an incomplete medical bill fulfills the insurance carrier's obligations with regard to the incomplete bill.

An insurance carrier must not combine bills submitted in separate envelopes as a single bill or separate single bills spanning several pages submitted in a single envelope.

  • AI arising out of california case management case management focus claims compensability compliance courts covid do you know the rule exclusive remedy florida FMLA glossary check Healthcare health care iowa leadership medical medicare minnesota NCCI new jersey new york ohio opioids osha pennsylvania Safety state info technology tennessee texas violence virginia WDYT west virginia what do you think women's history month workers' comp 101 workers' recovery workers' compensation contact information Workplace Safety Workplace Violence

  • Read Also

    About The Author

    • Frank Ferreri

      Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.

    Read More

    Request a Demo

    To request a free demo of one of our products, please fill in this form. Our sales team will get back to you shortly.