Texas Codes

Tex. Ins. Code § 1301.103 (2026)

Deadline For Action On Clean Claims

✓ current as of May 2026

Find cases: SyfertCases citing this section TX-LEGstatutes.capitol.texas.gov Justiaon Justia CornellLII Search CasesGoogle Scholar

Sec. 1301.103. DEADLINE FOR ACTION ON CLEAN CLAIMS. Except as provided by Sections 1301.104 and 1301.1054, not later than the 45th day after the date an insurer receives a clean claim from a preferred provider in a nonelectronic format or the 30th day after the date an insurer receives a clean claim from a preferred provider that is electronically submitted, the insurer shall make a determination of whether the claim is payable and:

(1) if the insurer determines the entire claim is payable, pay the total amount of the claim in accordance with the contract between the preferred provider and the insurer;

(2) if the insurer determines a portion of the claim is payable, pay the portion of the claim that is not in dispute and notify the preferred provider in writing why the remaining portion of the claim will not be paid; or

(3) if the insurer determines that the claim is not payable, notify the preferred provider in writing why the claim will not be paid.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Amended by:

Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.037(a), eff. September 1, 2005.

Acts 2011, 82nd Leg., R.S., Ch. 798 (H.B. 2292), Sec. 8, eff. September 1, 2011.

Notes of Decisions

Cited in 5 cases, 2012–2017 · leading case: Health Care Serv. Corp. v. Methodist Hospitals o, 814 F.3d 242 (5th Cir. 2016).

Sort: Relevance Newest Treatment

Health Care Serv. Corp. v. Methodist Hospitals o, 814 F.3d 242 (5th Cir. 2016). · cites it 2× “Tex Ins.Code § 1301.103. 4 . Id. § 1301.137(a) (imposing penalties when “a clean claim submitted to an insurer is payable and the insurer does not determine .”

Houston Methodist Hosp. v. Humana Ins. Co., 266 F. Supp. 3d 939 (S.D. Tex. 2017). · cites it 2× “Because the TPPA requires insurers receiving a “clean claim” first to “make a determination of whether the claim is payable” within 45 days for non-electronic claims and 30 days for electronic claims, Tex. Ins. Code § 1301.103, the TPPA mandates that ERISA insurers process and…”

Emergency Health Centre at Willowbrook, L.L.C. v. Unitedhealthcare of Texas, Inc., 892 F. Supp. 2d 847 (S.D. Tex. 2012). “Tex. Ins.Code § 1301.103 (version effective September 1, 2005, to August 31, 2011).”

Aetna Life Ins. v. Methodist Hospitals of Dallas, 640 F. App'x 314 (5th Cir. 2016). “Tex. Ins.Code § 1301.103. . Id. . See id.”

Aetna Life Ins. v. Methodist Hospitals of Dallas, 95 F. Supp. 3d 950 (N.D. Tex. 2015). “” Tex. Ins.Code Ann. § 1301.103. . Although the Aetna entity in state court (Aetna Health Insurance, Inc.”

Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.