Prompt Pay

Jul 30

As defined by the U.S. Department of the Treasury, “prompt pay” is a policy that “makes sure that valid and proper invoices submitted by vendors are paid on time by federal agencies.” In 2003, the state of Texas implemented its own Prompt Payment Act to ensure that doctors and other medical professionals were being fairly compensated for their services. Prior to the act, many insurance companies engaged in evasive business practices that cheated medical practitioners of the full compensation that they were entitled.

The Prompt Payment Act of 2013

As the Prompt Pay attorneys at Williams Kherkher explain, the Texas Prompt Pay Act of 2013 does not cover all insurance programs. Furthermore, not all physicians that provide patient care are eligible to pursue a Prompt Pay Act claim. Unfortunately, prompt pay laws are extremely complex, and medical professionals often enlist the help of experienced lawyers to help them determine their eligibility. The basic eligibility requirements for Prompt Pay include the following:

  • The patient must be insured by an entity covered by the Prompt Pay Act
  • The medical care provider must either have a written contract with the insurance company, have performed services in an emergency or its “attendant episode of care,” or have performed services at the request of the insurance company because an in-network doctor could not have “reasonably” performed the services.
  • The claim initially submitted to the insurance company must have been “clean”—complete, legible, and accurate.
  • The claim must have been submitted within 95 days of services rendered

There are occasionally exceptions made to these basic requirements, but such exceptions are extremely rare.

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