Tex. Ins. Code § 1301.134 · Subchapter C-1. OTHER PROVISIONS RELATING TO PAYMENT OF CLAIMS
COORDINATION OF PAYMENT.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) An insurer may require a physician or health care provider to retain in the physician's or provider's records updated information concerning other health benefit plan coverage and to provide the information to the insurer on the applicable form described by Section 1301.131. Except as provided by this subsection, an insurer may not require a physician or provider to investigate coordination of other health benefit plan coverage.
(b) Coordination of payment under this section does not extend the period for determining whether a service is eligible for payment under Section 1301.103 or 1301.104 or for auditing a claim under Section 1301.105.
(c) A physician or health care provider who submits a claim for particular medical care or health care services to more than one health maintenance organization or insurer shall provide written notice on the claim submitted to each health maintenance organization or insurer of the identity of each other health maintenance organization or insurer with which the same claim is being filed.
(d) On receipt of notice under Subsection (c), an insurer shall coordinate and determine the appropriate payment for each health maintenance organization or insurer to make to the physician or health care provider.
(e) Except as provided by Subsection (f), if an insurer is a secondary payor and pays a portion of a claim that should have been paid by the insurer or health maintenance organization that is the primary payor, the overpayment may only be recovered from the health maintenance organization or insurer that is primarily responsible for that amount.
(f) If the portion of the claim overpaid by the secondary insurer was also paid by the primary health maintenance organization or insurer, the secondary insurer may recover the amount of overpayment under Section 1301.132 from the physician or health care provider who received the payment. An insurer processing an electronic claim as a secondary payor shall rely on the primary payor information submitted on the claim by the physician or provider. Primary payor information may be submitted electronically by the primary payor to the secondary payor.
(g) An insurer may share information with a health maintenance organization or another insurer to the extent necessary to coordinate appropriate payment obligations on a specific claim.
(h) The provisions of this section may not be waived, voided, or nullified by contract.
Notes and commentary — not statutory text
History
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.037(b), eff. September 1, 2005.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1301.htm
- Text hash
- sha256 a317934b3f44a2bc8f393fbcf2a40a063e81c42aa971938fadf44d43018e0670
- 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
This section cites
Provisions in this library that the text above cites, as it prints each citation. A range cited as “ss. 61.13-61.16” links its first and last provisions.
Insurance Code
- Tex. Ins. Code § 1301.103DEADLINE FOR ACTION ON CLEAN CLAIMS.Printed as Section 1301.103 or 1301.104
- Tex. Ins. Code § 1301.104DEADLINE FOR ACTION ON PHARMACY CLAIMS; PAYMENT.Printed as Section 1301.103 or 1301.104
- Tex. Ins. Code § 1301.105AUDITED CLAIMS.Printed as Section 1301.105
- Tex. Ins. Code § 1301.131ELEMENTS OF CLEAN CLAIM.Printed as Section 1301.131
- Tex. Ins. Code § 1301.132OVERPAYMENT.Printed as Section 1301.132
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.