Texas Timely Filing Law

Overview

Texas Insurance Code §843.338 and §1301.103 establish timely filing deadlines for health insurers. Electronic claims must be processed within 30 days; non-electronic claims within 45 days. Claims not paid within these timeframes accrue interest at 18% per year, one of the highest rates in the nation.

Key Requirements

1. Electronically submitted clean claims must be decided and paid within 30 days of receipt.
2. Non-electronic clean claims must be decided and paid within 45 days of receipt.
3. Interest accrues at 18% per annum on unpaid claims after the deadline.
4. Insurers must provide written explanation of any missing information within 15 days of receipt.
5. Timely filing denials can only be invoked if the deadline was missed on submission, not on processing.

Penalties and Enforcement

The Texas Department of Insurance (TDI) enforces timely filing requirements through complaint investigation and regulatory action. Insurers that systematically violate timely filing deadlines face fines, license restrictions, or revocation. The 18% interest penalty compounds the financial impact, incentivizing prompt payment. Consumers can file complaints with TDI for violations.

Appeals and Exceptions

Timely filing denials can be appealed to the insurer and escalated to TDI for regulatory review. No statutory exceptions exist for incomplete claims—these must be rejected within the deadline or deemed paid. Providers can request claim status updates during the processing window.

Interaction with Federal Law

Texas timely filing requirements apply to health plans regulated under Texas Insurance Code. Federal ERISA standards for self-funded plans are less protective. Federal rules require decisions within 30 days, matching Texas electronic filing timelines.

Common Questions