Current with legislation from the 2023 Regular and Special Sessions signed by the Governor as of November 21, 2023.
Section 843.341 - Claims Processing Procedures(a) A health maintenance organization shall provide a participating physician or provider with copies of all applicable utilization review policies and claim processing policies or procedures.(b) A health maintenance organization's claims payment processes shall: (1) use nationally recognized, generally accepted Current Procedural Terminology codes, notes, and guidelines, including all relevant modifiers; and(2) be consistent with nationally recognized, generally accepted bundling edits and logic.Amended by Acts 2003, 78th Leg., ch. 214, Sec. 13, eff. 6/17/2003.Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. 6/1/2003.