Texas Administrative Code
Title 28 - INSURANCE
Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
Chapter 42 - MEDICAL BENEFITS
Subchapter B - MEDICAL COST EVALUATION
Section 42.145 - Billing
Universal Citation: 28 TX Admin Code ยง 42.145
Current through Reg. 49, No. 38; September 20, 2024
(a) General. All bills submitted to carriers shall:
(1) contain the identifying
information required by §
42.30(d)
of this title (relating to Written Communications), if available;
(2) itemize services and goods provided;
and
(3) after January 1, 1989,
identify services and goods provided by appropriate procedural and diagnostic
codes, with descriptions, as established in the fee guidelines.
(b) Billing by report.
(1) A provider shall bill by report when no
procedural definition and/or dollar value is established for a procedure, or
when a provider seeks payment in excess of that established in the fee
guidelines.
(2) The report shall:
(A) describe the procedure in sufficient
detail to permit evaluation;
(B)
contain substantiating documentation to establish the fairness and
reasonableness of the charge(s); and
(C) include correct diagnostic codes and
descriptions, when appropriate.
(3) The report shall be attached to the
bill.
(c) Billing requirements. Failure to comply with billing requirements shall suspend the carrier's obligation to review the bill. The carrier shall return a noncompliant bill to the provider within three working days of receipt.
(d) Billing forms. The board may prescribe forms for billing purposes.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
