Texas SB1811 prohibits health maintenance organizations and insurers from using extrapolation in audits of physicians and providers.

Texas SB1811 amends the Insurance Code to prohibit health maintenance organizations and insurers from using extrapolation in audits of physicians and providers. Extrapolation refers to a mathematical process used to estimate audit results for claims not reviewed. The bill mandates that any additional payment or refund must be based on actual overpayments or underpayments, not on extrapolation. The changes apply to audits of physicians and providers under contracts with insurers or health maintenance organizations entered into or renewed after the bill's effective date of September 1, 2025.

Texas SB1811 prohibits health maintenance organizations and insurers from using extrapolation in audits of physicians and providers.

Texas SB1811 amends the Insurance Code to prohibit health maintenance organizations and insurers from using extrapolation in audits of physicians and providers. Extrapolation refers to a mathematical process used to estimate audit results for claims not reviewed. The bill mandates that any additional payment or refund must be based on actual overpayments or underpayments, not on extrapolation. The changes apply to audits of physicians and providers under contracts with insurers or health maintenance organizations entered into or renewed after the bill's effective date of September 1, 2025.