Texas HB4585 amends laws regarding the submission, payment, and audit of claims for health services under Medicaid and child health plans.

Texas HB4585 amends the Government Code to require Medicaid managed care organizations to pay physicians or providers for clean claims within specific timeframes. It mandates that these organizations develop systems for tracking and resolving provider appeals. The bill also prohibits delegation of utilization review to artificial intelligence applications. Additionally, it amends the Insurance Code to allow utilization review agents to delegate review to qualified personnel in hospitals or health care facilities. HB4585 takes effect September 1, 2025.

Texas HB4585 amends laws regarding the submission, payment, and audit of claims for health services under Medicaid and child health plans.

Texas HB4585 amends the Government Code to require Medicaid managed care organizations to pay physicians or providers for clean claims within specific timeframes. It mandates that these organizations develop systems for tracking and resolving provider appeals. The bill also prohibits delegation of utilization review to artificial intelligence applications. Additionally, it amends the Insurance Code to allow utilization review agents to delegate review to qualified personnel in hospitals or health care facilities. HB4585 takes effect September 1, 2025.