Texas HB4549 amends the Insurance Code to establish deadlines for health maintenance organizations and insurers to act on clean claims and recover.

HB4549 amends the Texas Insurance Code to set specific deadlines for health maintenance organizations and insurers to process clean claims and recover overpayments. Health maintenance organizations must determine whether a clean claim is payable within 45 days of receipt, paying the full amount if payable or notifying the provider in writing if not. Insurers must also determine claim payability within 45 days, paying the full amount if payable or notifying the provider in writing if not.

Texas HB4549 amends the Insurance Code to establish deadlines for health maintenance organizations and insurers to act on clean claims and recover.

HB4549 amends the Texas Insurance Code to set specific deadlines for health maintenance organizations and insurers to process clean claims and recover overpayments. Health maintenance organizations must determine whether a clean claim is payable within 45 days of receipt, paying the full amount if payable or notifying the provider in writing if not. Insurers must also determine claim payability within 45 days, paying the full amount if payable or notifying the provider in writing if not.