Texas HB1641 prohibits health maintenance organizations and insurers from using extrapolation in audits of physicians and providers.

Texas HB1641 amends the Insurance Code to prohibit health maintenance organizations and insurers from using extrapolation in audits of physicians and providers. Extrapolation is defined as a mathematical process used to estimate audit results for claims not reviewed. The bill specifies that any additional payment or refund must be based on actual overpayments or underpayments, not on extrapolation. This change applies to audits of physicians and providers under contracts entered into or renewed after the effective date of the Act. The Act takes effect September 1, 2025.

Texas HB1641 prohibits health maintenance organizations and insurers from using extrapolation in audits of physicians and providers.

Texas HB1641 amends the Insurance Code to prohibit health maintenance organizations and insurers from using extrapolation in audits of physicians and providers. Extrapolation is defined as a mathematical process used to estimate audit results for claims not reviewed. The bill specifies that any additional payment or refund must be based on actual overpayments or underpayments, not on extrapolation. This change applies to audits of physicians and providers under contracts entered into or renewed after the effective date of the Act. The Act takes effect September 1, 2025.