Texas Insurance Code
CHAPTER TWENTY A--HEALTH MAINTENANCE ORGANIZATION ACT

Art. 20A.09. Evidence of Coverage and Charges.

Text of article as amended by Acts 1997, 75th Leg., ch. 163, Sec. 5, Acts 1997, 75th Leg., ch. 837, Sec. 4.01, Acts 1997, 75th Leg., ch. 1023, Acts 1997, 75th Leg., ch. 1026, Sec. 7

(j) A health maintenance organization shall comply with Article 21.55 of the Insurance Code with respect to prompt payment to enrollees. A health maintenance organization shall make payment to a physician or provider for covered services rendered to enrollees of the health maintenance organization not later than the 45th day after the date a claim for payment is received with documentation reasonably necessary for the health maintenance organization to process the claim or, if applicable, within the number of calendar days specified by written agreement between the physician or provider and the health maintenance organization. For purposes of this subsection, "covered services" means health care services and benefits to which enrollees are entitled under the terms of an applicable evidence of coverage.