78th Texas Legislature, Regular Session, Senate Bill 418, Chapter 214 Page: 1 of 54
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CHAPTER 214 S.B. No. 418
1 AN ACT
2 relating to the regulation and prompt payment of health care
3 providers; providing penalties.
4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
5 SECTION 1. Section 1, Article 3.70-3C, Insurance Code, as
6 added by Chapter 1024, Acts of the 75th Legislature, Regular
7 Session, 1997, is amended by adding Subdivisions (14) and (15) to
8 read as follows:
9 (14) "Preauthorization" means a determination by an
10 insurer that medical care or health care services proposed to be
11 provided to a patient are medically necessary and appropriate.
12 (15) "Verification" means a reliable representation
13 by an insurer to a physician or health care provider that the
14 insurer will pay the physician or provider for proposed medical
15 care or health care services if the physician or provider renders
16 those services to the patient for whom the services are proposed.
17 The term includes precertification, certification,
18 recertification, and any other term that would be a reliable
19 representation by an insurer to a physician or provider.
20 SECTION 2. -Section 3A, Article 3.70-3C, Insurance Code, as
21 added by Chapter 1024, Acts of the 75th Legislature, Regular
22 Session, 1997, is amended to read as follows:
23 Sec. 3A. PROMPT PAYMENT OF [PRE ERRED] PROVIDERS. (a) In
24 this section, "clean claim" means a [empetad] claim that complies1
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Texas. Legislature. Senate. 78th Texas Legislature, Regular Session, Senate Bill 418, Chapter 214, legislative document, June 17, 2003; [Austin, Texas]. (https://texashistory.unt.edu/ark:/67531/metapth159426/m1/1/: accessed March 29, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.