28 Tex. Admin. Code § 133.3 - Communication Between Health Care Providers and Insurance Carriers
(a) Any communication between the health care
provider and insurance carrier related to medical bill processing shall be of
sufficient, specific detail to allow the responder to easily identify the
information required to resolve the issue or question related to the medical
bill. Generic statements that simply state a conclusion such as "insurance
carrier improperly reduced the bill" or "health care provider did not document"
or other similar phrases with no further description of the factual basis for
the sender's position does not satisfy the requirements of this
section.
(b) Communication between
the health care provider and insurance carrier related to medical bill
processing shall be made by telephone or electronic transmission unless the
information cannot be sent by those media, in which case the sender shall send
the information by mail or personal delivery.
(c) Health care providers and insurance
carriers shall maintain, in a reproducible format, documentation of
communications related to medical bill processing.
Notes
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