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Legislative Information
Q. Is there an indicator on the ID card that shows if a group is subject to Texas Prompt Pay Legislation?
A. Yes, the letters “TDI” will be on the front of the member’s ID card beginning with cards issued January 15, 2004. The indicator will be added to cards as new groups enroll or existing groups renew.
Q. Does Texas Prompt Pay Legislation apply to out-of-network providers?
A. If the services were provided under a referral or precertification or in the event of an emergency, Texas Prompt Pay Legislation would apply to out-of-network providers.
Q. Are Wal-Mart employees subject to Texas Prompt Pay Legislation?
A. Wal-Mart is excluded based on criteria established by the Texas Department of Insurance.
Q. Will groups currently excluded from TDI jurisdiction ever become subject to their jurisdiction?
A. Groups are subject to TDI jurisdiction for different reasons including their funding arrangement. If circumstances change, the group may then become subject to TDI jurisdiction. Groups not covered under TDI jurisdiction generally fall under federal regulations.
Q. Does TDI have jurisdiction over HMOs?
A. Yes, TDI does have jurisdiction over the HMO Blue Texas plan.
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Q. Where can I find Texas Department of Insurance (TDI) information online?
A. For additional TDI information, please visit the Texas Department of Insurance site.
Q. Where can I find changes and updates to TDI rules?
A: There are several options on the TDI Regulation/Legal page of the Texas Department of Insurance site.
Q. We were told that if we send a complaint to the Texas Department of Insurance (TDI), we will not receive a response from BCBSTX. Is that correct?
A. Complaints filed directly with TDI receive a response directly from TDI. To clarify, the complaint process for TDI is as follows: TDI forwards a copy or your complaint to BCBSTX for review and/or resolution. We respond to TDI, which in turn will notify you directly of the outcome. BCBSTX will not respond directly to you once a complaint has been received from TDI.
Q. What is the claims filing deadline?
A. All HMO Blue Texas and Blue Medicare PPO claims must be filed within 180 days of the date of service. POS/PPO and ParPlan claims must be filed within 365 days of the date of service.
Q. Can carriers delay or deny claims processing if they are waiting on information from the member?
A. For members subject to Prompt Pay Legislation, BCBSTX can request information from the treating physician without finalizing claim payment. If there is any other information needed from another source, we will not delay payment. Upon receipt of the additional information from the other source, if the information alters our decision, additional payment of refund notice will be issued accordingly.
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