Testimony Opposing HB 3195: Claims Payment Review Process

TAHP is opposed to HB  3195, as it would create a new claims payment review process that is unworkable and would create challenges in recovering any claims overpayment. However, TAHP has offered language to the bill author’s office that would address our concerns. 

While some of the provisions in the bill are either acceptable or already required, the most significant concern is with the external advisory review panel for all overpayment and audit appeals. The mandated process of convening three practicing network physicians of the same specialty or provider type to review each claim appeal would be, quite literally, impossible to accomplish. This would result in health plans effectively being required to make initial payments under prompt pay laws before being able to investigate claims and then being prohibited from reviewing those claims after payment. 

Read the full letter.

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