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Insurer says:
“Pending receipt of accident report…”
Your response:
“Accident report is not necessary for processing this claim. The Texas Insurance Code only requires providers to submit additional information that is “relevant and necessary” if the request is timely made by your company, in writing, and stating the reasons for the request. Furthermore, under no circumstances are providers required to submit information that is not maintained by us, in our office. You need to be aware that continued delay of this claim could subject your company to additional penalties.”
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Texas Insurance Code § 1301.101, 843.336
“If an insurer needs additional information from a treating preferred provider, the insurer not later than the 30th calendar day…shall request in writing …an attachment to the claim that is relevant and necessary… must describe with specificity the clinical information requested and … relate only to the information the insurer can demonstrate is specific to the claim or the claims episode of care. An HMO or preferred provider may only require …information that is either contained in or in the process of being incorporated into a patient’s medical of billing record maintained by the physician or provider.”
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