Tex. Ins. Code § 843.336 · Subchapter J. PAYMENT OF CLAIMS TO PHYSICIANS AND PROVIDERS
DEFINITION.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) In this subchapter, "clean claim" means a claim that complies with this section.
(b) A nonelectronic claim by a physician or provider, other than an institutional provider, is a clean claim if the claim is submitted using the Centers for Medicare and Medicaid Services Form 1500 or, if adopted by the commissioner by rule, a successor to that form developed by the National Uniform Claim Committee or its successor. An electronic claim by a physician or provider, other than an institutional provider, is a clean claim if the claim is submitted using the Professional 837 (ASC X12N 837) format or, if adopted by the commissioner by rule, a successor to that format adopted by the Centers for Medicare and Medicaid Services or its successor.
(c) A nonelectronic claim by an institutional provider is a clean claim if the claim is submitted using the Centers for Medicare and Medicaid Services Form UB-92 or, if adopted by the commissioner by rule, a successor to that form developed by the National Uniform Billing Committee or its successor. An electronic claim by an institutional provider is a clean claim if the claim is submitted using the Institutional 837 (ASC X12N 837) format or, if adopted by the commissioner by rule, a successor to that format adopted by the Centers for Medicare and Medicaid Services or its successor.
(d) The commissioner may adopt rules that specify the information that must be entered into the appropriate fields on the applicable claim form for a claim to be a clean claim.
(e) The commissioner may not require any data element for an electronic claim that is not required in an electronic transaction set needed to comply with federal law.
(f) A health maintenance organization and a physician or provider may agree by contract to use fewer data elements than are required in an electronic transaction set needed to comply with federal law.
(g) An otherwise clean claim submitted by a physician or provider that includes additional fields, data elements, attachments, or other information not required under this section is considered to be a clean claim for the purposes of this section.
Notes and commentary — not statutory text
History
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003. Amended by Acts 2003, 78th Leg., ch. 214, Sec. 6, eff. June 17, 2003.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.843.htm
- Text hash
- sha256 5dc4e767f71065229c2c01ebefa4d8317cb60876dace806ebac0ab50e60ee75e
- 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 6 provisions
Provisions in this library whose text cites Tex. Ins. Code § 843.336. Each shows the citation as that text prints it.
Insurance Code
- Tex. Ins. Code § 843.349COORDINATION OF PAYMENT.Printed as Section 843.336
- Tex. Ins. Code § 843.353WAIVER PROHIBITED.Printed as Sections 843.336(f) and 843.337(c)
- Tex. Ins. Code § 1271.155EMERGENCY CARE.Printed as Section 843.336
- Tex. Ins. Code § 1271.157NON-NETWORK FACILITY-BASED PROVIDERS.Printed as Section 843.336
- Tex. Ins. Code § 1271.158NON-NETWORK DIAGNOSTIC IMAGING PROVIDER OR LABORATORY SERVICE PROVIDER.Printed as Section 843.336
- Tex. Ins. Code § 1271.159NON-NETWORK EMERGENCY MEDICAL SERVICES PROVIDER.Printed as Section 843.336
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.