Bill > HB1641

This bill prohibits health maintenance organizations (HMOs) and insurers from using extrapolation as a method for auditing claims submitted by participating physicians, providers, or preferred providers. Extrapolation is defined as a mathematical technique used to estimate audit results for a larger group of claims based on a sample review, rather than examining each individual claim. Under the new law, any additional payments or refunds must be based solely on actual overpayments or underpayments identified in the specific claims reviewed, not on projected or estimated amounts. The bill specifically amends sections of the Texas Insurance Code to implement this prohibition, and the changes will apply only to contracts with HMOs or insurers that are entered into or renewed on or after the effective date of September 1, 2025. The bill does not apply to certain government health benefit plans, such as the child health plan program or Medicaid programs, ensuring that the extrapolation ban is limited to private health care contracts.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB1641