Texas Lawyers for Health Care Providers With Prompt Payment Violation Claims
Texas law requires preferred provider organizations (PPOs) and health maintenance organizations (HMOs) to pay so-called "clean claims" no later than the 45th day after receiving it from the billing physician or hospital, unless the insurer notifies the party submitting the claim of an intention to withhold some or all of the payment, usually in connection with a claim audit.
If you handle accounts receivable or insurance claims for a Texas hospital, clinic or medical practice group and you have questions about your rights under the Texas Prompt Pay Act (TPPA), contact the Provost Umphrey Law Firm L.L.P. in Beaumont or Tyler. Our experience with prompt-pay claims on behalf of health care providers throughout the state can make a positive difference in your cash flow. Our familiarity with the interest, penalty and attorney fee provisions of the TPPA can also minimize the transaction costs of asserting your right to prompt payment while increasing your net amount recovered.
Texas PPOs and HMOs Must Pay Promptly — Notwithstanding ERISA
For some years many believed that Texas law on prompt payment by health care insurers was preempted by federal law to the extent that the right to medical insurance was an employee benefit regulated by ERISA. Recent decisions, however, by the Fifth Circuit Court of Appeals have made clear that while ERISA might govern questions as to whether a claim for payment is valid, the Texas Department of Insurance (TDI) can regulate the rate and timing of payments of undisputed validity. As a result, Texas health care providers are entitled to prompt payment of clean claims within the statutory 45-day period.
Provost Umphrey attorneys can advise you about your right to prompt payment in a variety of situations when the PPO or HMO you're dealing with is delaying payment. We can let you know whether your invoices were sent in the proper form and with proper documentation. We can advise you about the merits of any objections or requests for further information that the insurer might have sent. In many cases, our intervention at an early stage of a payment impasse can convince the insurer of the advisability of paying the claim immediately and in full.
For more information about the most effective ways to protect your interests as a health care provider in prompt payment of PPO or HMO claims, contact the Provost Umphrey Law Firm in Beaumont or Tyler.