28 Tex. Admin. Code § 134.800
Required Billing Forms and Information
Effective Apr 28, 200530 TexReg 2398Source Note: The provisions of this §134.800 adopted to be effective February 20, 1991, 16 TexReg 671; amended to be effective June 1, 1992, 17 TexReg 3250; amended to be effective July 15, 2000, 25 TexReg 2139; amended to be effective July 11, 2004, 29 TexReg 6303; amended to be effective April 28, 2005, 30 TexReg 2398.Texas Secretary of State
- (a) Except as provided by §134.801 of this title (relating to Submitting Medical Bills for Payment), health care providers shall submit medical bills for payment on standard forms used by the Centers for Medicare and Medicaid Services (CMS), applicable forms prescribed in subsections (b), (c), and (d), completed in accordance with Commission instructions, or electronic transmissions submitted in accordance with subsection (e) of this section. All information on medical bills shall be legible when submitted.
- (b) Except as provided in subsections (c), (d), and (e) of this section, all health care providers, as defined in §401.011 of the Texas Labor Code, shall submit medical bills using national standard health insurance claim forms, prepared according to Commission instructions.
- (c) Pharmacists shall submit bills using the Commission form TWCC-66, Statement for Pharmacy Services, prepared according to Commission instructions.
- (d) Dentists shall submit bills using a billing form currently approved by the American Dental Association prepared according to Commission instructions.
- (e) Health care providers and the insurance carrier may mutually agree to exchange medical bill and reimbursement data electronically. The mutual agreement shall stipulate the elements that constitute a complete electronic medical bill and the method and manner related documentation is submitted to the insurance carrier. For the purposes of this subsection, electronic billing and reimbursement excludes transmission by facsimile or electronic mail.
- (f) The Commission may order the health care provider to reimburse a carrier when the carrier pays the health care provider in excess of the amount allowed by the appropriate Commission fee guideline.
Source Note:The provisions of this §134.800 adopted to be effective February 20, 1991, 16 TexReg 671; amended to be effective June 1, 1992, 17 TexReg 3250; amended to be effective July 15, 2000, 25 TexReg 2139; amended to be effective July 11, 2004, 29 TexReg 6303; amended to be effective April 28, 2005, 30 TexReg 2398.