Finances


What is the Texas Prompt Pay Act?


Posted By on May 4, 2015

Medical professionals play crucial roles in their respective communities. Thanks to the hard work of doctors, nurses, and other health care providers, communities are able to receive proper medical attention and treatment. Unfortunately, there are scenarios when this hard work isn’t properly compensated by insurance companies that delay or deny medical care payments.

In Texas, medical professionals are protected from such antagonistic practices through the Texas Prompt Pay Act of 2003. Based on the terms mandated by the Texas Prompt Pay statute, medical personnel who are not properly paid by health insurance companies within a specific space of time may pursue their owed compensation through a legal claim.

It’s important to note that note all health insurance programs can be covered by the Prompt Pay Act. The law only applies to health maintenance organizations (HMO) and preferred provider organizations (PPO). Any other insurance plan under the following programs is exempted from the mandated terms:

  • Workers’ Compensation
  • Federal employee plans
  • Self-funded plans for ERISA, and University of Texas and Texas A&M University employees
  • Texas Association of School Board coverage
  • Health Select and Health Select Plus
  • TriCare
  • CHIP
  • Medicare
  • Medicaid

Medical professionals looking for coverage outside the aforementioned programs will need to submit their claims within 95 days of the services they rendered. Their submission must also include data that is, as stated by the law, “complete, legible, and accurate.” These claims will also have to undergo strict review and should follow other eligibility requirements mandated in the Texas Prompt Act. Because this process can quickly become complicated so often, doctors and other health care personnel should feel free to consult with an experienced lawyer to learn more about all the legal options available to them.

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