Texas Workers' Compensation

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§ 133.3. Communication Between Health Care Providers and Insurance Carriers

(a) Any communication between the health care provider and insurance carrier related to medical bill processing shall be of sufficient, specific detail to allow the responder to easily identify the information required to resolve the issue or question related to the medical bill. Generic statements that simply state a conclusion such as “insurance carrier improperly reduced the bill” or “health care provider did not document” or other similar phrases with no further description of the factual basis for the sender’s position does not satisfy the requirements of this section.

(b) Communication between the health care provider and insurance carrier related to medical bill processing shall be made by telephone or electronic transmission unless the information cannot be sent by those media, in which case the sender shall send the information by mail or personal delivery.

(c) Health care providers and insurance carriers shall maintain, in a reproducible format, documentation of communications related to medical bill processing.

The provisions of this § 133.3 adopted to be effective May 2, 2006, 31 TexReg 3544.

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At a Glance:

Title:

§ 133.3. Communication Between Health Care Providers and Insurance Carriers

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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