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S.B. No. 50
AN ACT
relating to contracts between health care providers and certain
health benefit plan issuers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
amended by adding Section 843.323 to read as follows:
Sec. 843.323. CONTRACT PROVISIONS PROHIBITING REJECTION OF
BATCHED CLAIMS. (a) If requested by a participating physician or
provider, a health maintenance organization shall include a
provision in the physician's or provider's contract providing that
the health maintenance organization or the health maintenance
organization's clearinghouse may not refuse to process or pay an
electronically submitted clean claim, as defined by Subchapter J,
because the claim is submitted together with or in a batch
submission with a claim that is not a clean claim.
(b) In accordance with Chapters 82 and 84, the commissioner
may issue a cease and desist order against or impose sanctions on a
health maintenance organization that violates this section or a
contract provision adopted under this section.
SECTION 2. Subchapter B, Chapter 1301, Insurance Code, as
effective April 1, 2005, is amended by adding Section 1301.0641 to
read as follows:
Sec. 1301.0641. CONTRACT PROVISIONS PROHIBITING REJECTION
OF BATCHED CLAIMS. (a) If requested by a preferred provider, an
insurer shall include a provision in the preferred provider's
contract providing that the insurer or the insurer's clearinghouse
may not refuse to process or pay an electronically submitted clean
claim, as defined by Subchapter C, because the claim is submitted
together with or in a batch submission with a claim that is not a
clean claim.
(b) In accordance with Chapters 82 and 84, the commissioner
may issue a cease and desist order against or impose sanctions on an
insurer that violates this section or a contract provision adopted
under this section.
SECTION 3. The change in law made by this Act applies only
to a contract between an insurer and a preferred provider or a
health maintenance organization and a physician or provider that is
entered into or renewed on or after January 1, 2006. A contract
entered into before January 1, 2006, is governed by the law in
effect immediately before the effective date of this Act, and that
law is continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2005.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 50 passed the Senate on
March 31, 2005, by the following vote: Yeas 30, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 50 passed the House on
May 20, 2005, by a non-record vote.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor