Managed Care Payor Resource Page

Commissioner Bulletins

• Commissioner´s Bulletin NO. B-0008-05 (February 2005)
• Commissioner´s Bulletin NO. B-0017-04
• Commissioner´s Bulletin NO. B-0004-04 (January 2004) | PDF | MS Word
• Commissioner´s Bulletin NO. B-0042-03 (October 2003)
• Commissioner´s Bulletin NO. B-0041-03 (October 2003)
• Commissioner´s Bulletin No. B-0012-02 (April 2002)
• Commissioner´s Bulletin NO. B-0023-01 (May 2001)

Rules

• SB418 Adopted Rules on Batch Rejection, Annual Verification Reporting Date, Underpayment Penalty Calculation, Preauthorization and Verification Availability for Dental and Vision HMOs, and Eligibility Information
  • Preferred Provider Plans
  • Physician and Provider Contracts and Arrangements
  • Utilization Review Agents
  • Submission of Clean Claims
  • Eligibility Statements
• SB 418 - Submission of Clean Claims Proposed Rules Summary (October 2003)
  • Submission of Clean Claims/Waiver of Electronic Filing Requirements (April 2004)
  • Submission of Clean Claims/Reporting Requirements for Pharmacy Claims (April 2004)
  • Submission of Clean Claims/Identification (ID)Cards
  • Submission of Clean Claims/Required Data Elements/Dental
  • Submission of Clean Claims/Waiver of Statutory Provisions
• SB 418 - Prompt Payment of Health Care Claims Emergency Rules Summary (August 2003)
• SB 418 - Prompt Payment of Health Care Claims Proposed Rules Summary (June 2003)
• HB 610 - Prompt Payment of Health Care Claims Rules (September 2001)
• HB 610 - Prompt Payment of Health Care Claims Rules (May 2000)

Technical Advisory Committee

• Technical Advisory Committee on Claims Processing (TACCP)

Education

• "Finding Your Way to Prompt Pay" (MS PowerPoint slide show) | zip | pdf
• Self Funded ERISA vs. Fully funded Identification on cards | MS Word | pdf
• Submission and Prompt Pay of Clean Claims (SB 418 and HB 610 comparison) | MS Word | pdf
• Provider Contracting Requirements | MS Word | pdf
• Verification and Preauthorization Procedures | MS Word | pdf
• Verification Requirements | MS Word | pdf
• CMS 1500 - Texas Clean Claims Elements | MS Word | pdf
• UB 92 - Texas Clean Claims Elements | MS Word | pdf
• SB 418 Provisions for HMOs | MS Word | pdf
• SB 418 Provisions for PPOs | MS Word | pdf
• Timelines | MS Word | pdf
• SB 418 FAQs
• HB 610 Prompt Pay FAQs
• HB 610 Claims Payment FAQs

Enforcement

• April 29, 2002 Restitution/Fines (as of July 2002)
• April 1, 2002 Restitution/Fines (as of June 2002)
• January 2002 Restitution Summary
• Life, Health and Licensing 2002 Compliance Workshop Introduction
• Montemayor Approves Clean Claim Improvements
• Montemayor Compels Restitution for Doctors/Providers and Issues $9.25 Million in Fines

For more payor information, click on the links below:

• Life, Health and Licensing 2004 Compliance Workshop
• Life, Health and Licensing 2002 Compliance Workshop
• Commissioner´s Bulletin NO. B-0012-02
• Submission of Clean Claims Rules
• Commissioner´s Bulletin NO. B-0023-01
• June 25 Prompt Payment Workshop for Insurance Companies

For more information contact: ConsumerProtection@tdi.state.tx.us