Compliance Corner: Texas Insurance Carriers & Incomplete Medical Bills

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.

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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.

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