Tex. Gov't Code § 540.0265 · Subchapter F. REQUIRED CONTRACT PROVISIONS
PROMPT PAYMENT OF CLAIMS.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) A contract to which this subchapter applies must require the contracting Medicaid managed care organization to pay a physician or provider for health care services provided to a recipient under a Medicaid managed care plan on any claim for payment the organization receives with documentation reasonably necessary for the organization to process the claim:
(1) not later than:
(A) the 10th day after the date the organization receives the claim if the claim relates to services a nursing facility, intermediate care facility, or group home provided;
(B) the 30th day after the date the organization receives the claim if the claim relates to the provision of long-term services and supports not subject to Paragraph (A); and
(C) the 45th day after the date the organization receives the claim if the claim is not subject to Paragraph (A) or (B); or
(2) within a period, not to exceed 60 days, specified by a written agreement between the physician or provider and the organization.
(b) A contract to which this subchapter applies must require the contracting Medicaid managed care organization to demonstrate to the commission that the organization pays claims described by Subsection (a)(1)(B) on average not later than the 21st day after the date the organization receives the claim.
Notes and commentary — not statutory text
History
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/GV/htm/GV.540.htm
- Text hash
- sha256 9bbe4dda1cce99284ef7c55693142ec9fb48a20b5a7629a248422522838b7e19
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Cited by 1 provision
Provisions in this library whose text cites Tex. Gov't Code § 540.0265. Each shows the citation as that text prints it.
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