Texas Timely Billing Law: A Guide to Chapter 146 and the 95 Day Rule
In Texas, “timely billing” points to two different due dates. They explain how fast a health care provider must send a bill after treatment ends. The first due date listed is in the Texas Civil Practice and Remedies Code (Chapter 146). It covers bills sent to patients. In many cases, it also covers bills sent to health plan issuers. The second due date is often called the 95 day rule. This one is found in the Texas Insurance Code. It applies to claims sent to managed care plans, like HMOs and PPOs. Missing these deadlines is not a small issue. If a provider does not follow them, the right to collect payment may be taken away. This guide explains both rules. It also lays out when each rule applies and what occurs when a claim is sent late.
What Counts as Timely Billing in Texas
Two different statutory frameworks are involved, and they are not interchangeable. Chapter 146 of the Civil Practice and Remedies Code governs the relationship between a provider and a patient, or between a provider and a health plan issuer when no contract sets a different deadline. The 95 day rule, found in the Texas Insurance Code and its implementing regulations, governs claims a provider submits to a managed care carrier. Which rule applies in a given case depends on how the patient is covered, a distinction covered later in this guide.
The 11th Month Rule Under Section 146.002
Section 146.002 of the Civil Practice and Remedies Code is often called the 11th month rule. This section states that a bill for services given to a patient must be sent by the first day of the 11th month after the service date. It does not depend on a neat calendar year. If the service happens on any day in a month, the bill still has to be sent before the first day of the next 11th month.
Billing the Patient Directly
Under Subsection (a), a patient or other responsible person must be billed within the 11 month window described above. This is the default deadline that applies whenever a provider bills a patient directly.
Billing a Health Plan Issuer or Third Party Payor
Under Subsections (b) and (c), a different standard applies when a provider is required or authorized to bill a health benefit plan issuer, or a third party payor operating under federal or state law, such as Medicare or Medicaid, directly. In those cases, the applicable deadline is whatever is set by contract between the provider and the payor. Only when no such contract exists does the same 11th month deadline apply by default.
How the Date of Billing Is Determined
Under Subsection (d), the bill is treated as sent on the day it is mailed. The mailing must be done with postage prepaid. It must go to the patient, the responsible person, or (after the 2025 change described below), the patient’s attorney. The mailing address must be the one listed in the provider’s records. If the bill is sent to a health plan issuer or a third party payor, the billing date follows the payor rules. In that case, the billing date is when the claim is mailed or otherwise submitted.
The 2025 Personal Injury Billing Amendment
House Bill 4145, passed unanimously by the Texas Senate and by a vote of 144 to 4 in the House, took effect September 1, 2025. It added Subsection (c-1) to Section 146.002, addressing a specific dispute that had been arising in personal injury cases. Some parties had argued that a provider’s bill sent to a patient’s attorney, rather than to the patient personally, did not satisfy the 11 month requirement, since the attorney was not a responsible person under the statute. Subsection (c-1) resolves this directly: when a patient is represented by an attorney in a personal injury claim, a provider may satisfy the billing requirement by sending the bill to that attorney instead of the patient, unless the patient or responsible person directs otherwise, provided the bill is still sent within the same 11 month window.
The 95 Day Rule for Managed Care Claims
A separate and shorter deadline applies when a claim is submitted to a managed care carrier, meaning an HMO or PPO regulated under Chapter 843 or Chapter 1301 of the Texas Insurance Code. Under Texas Insurance Code Sections 1301.102(a) and 843.337, and their implementing regulation, 28 Texas Administrative Code Section 21.2806, a physician or provider must submit a claim to a managed care carrier no later than the 95th day after the date the service was delivered.
When the 95 Day Clock Starts
- For most claims, the count begins on the date the service was delivered.
- For an institutional provider, such as a hospital, the count does not begin until the date of the patient’s discharge.
- For a secondary claim involving coordination of benefits, the 95 day period does not begin until the provider receives the primary payor’s determination.
A managed care carrier and a provider may agree by contract to extend this deadline, but the deadline cannot be shortened by contract. An exception exists for catastrophic events: if a documented event interrupts a provider’s normal operations for at least two consecutive business days, the statutory deadline is suspended for the length of that interruption, provided TDI is notified within the timeframes set by rule.
A claim filed after the 95 day deadline, without a qualifying exception, results in forfeiture of the provider’s right to payment for that claim.
Chapter 146 or the 95 Day Rule: Which Deadline Applies
According to guidance published by the Texas Department of Insurance, the deadline that governs a given claim depends on how the patient is covered. Claims involving a patient covered under a managed care carrier plan are subject to the 95 day rule for submission to that carrier. Claims involving a patient who is not covered under a managed care carrier plan fall under the Chapter 146 deadlines described above.
| Billing Scenario | Governing Law | Deadline |
|---|---|---|
| Bill sent to a patient or responsible person | Civil Practice and Remedies Code Section 146.002 | First day of the 11th month after service |
| Bill sent to a patient's attorney in a personal injury claim | Section 146.002(c-1) | First day of the 11th month after service |
| Bill sent to a health plan issuer or third party payor, no contract in place | Section 146.002(b) or (c) | First day of the 11th month after service |
| Claim submitted to a managed care carrier (HMO or PPO) | Insurance Code Sections 1301.102(a) and 843.337; 28 TAC Section 21.2806 | 95th day after service, or after discharge for institutional providers |
How the 95 Day Rule Connects to the Insurance Code Prompt Pay Provision
The 95 day rule and the Texas Insurance Code’s prompt pay provisions govern opposite sides of the same claim. The 95 day rule is the deadline by which a provider must submit a claim. The prompt pay provisions, found in Texas Insurance Code Sections 843.338, 843.342, 1301.103, and 1301.137, along with 28 Texas Administrative Code Sections 21.2807 and 21.2815, set the deadline by which the carrier must act on a claim once it is received, and the penalty owed if that deadline is missed.
| Billing Scenario | Governing Law | Deadline |
|---|---|---|
| Bill sent to a patient or responsible person | Civil Practice and Remedies Code Section 146.002 | First day of the 11th month after service |
| Bill sent to a patient's attorney in a personal injury claim | Section 146.002(c-1) | First day of the 11th month after service |
| Bill sent to a health plan issuer or third party payor, no contract in place | Section 146.002(b) or (c) | First day of the 11th month after service |
| Claim submitted to a managed care carrier (HMO or PPO) | Insurance Code Sections 1301.102(a) and 843.337; 28 TAC Section 21.2806 | 95th day after service, or after discharge for institutional providers |
Financial Forfeiture Penalties Under Section 146.003
Section 146.003 sets out the consequence for missing the Chapter 146 deadline, and the language is specific. A provider who violates Section 146.002 may not recover from the patient any amount the patient would have been entitled to receive as payment or reimbursement under a health benefit plan, and may not recover any amount the patient would not otherwise have been obligated to pay, had the provider billed on time. In effect, the provider forfeits the ability to collect the portion of the charge that timely billing would have allowed the health plan to cover.
The bar extends beyond the patient. If recovery from the patient is barred under this section, the provider is also barred from recovering the same debt from any other individual who would otherwise be responsible for it because of a family or personal relationship with the patient.
Section 146.004 limits the scope of this penalty in one respect: a violation of the timely billing requirement does not, by itself, expose the provider to disciplinary action under any licensing law. The consequence is financial forfeiture, not a separate professional discipline matter.
Practical Compliance Notes for Texas Medical Billing
Two separate clocks, an 11 month deadline and a 95 day deadline, cannot be tracked the same way. A claim wrongly assumed to fall under the longer Chapter 146 window, when the patient is actually covered under a managed care plan, can miss the 95 day filing deadline well before anyone notices a problem. Confirming a patient’s coverage type at intake, rather than at the point a claim is finally submitted, is what keeps both deadlines from being missed.
Plan type verification of exactly this kind is built into the front end of the claims process at Vigilant Medical Billing, so a claim’s filing deadline is identified before the clock starts running, not after it has already expired.
Conclusion
Two deadlines govern timely billing in Texas, and each is tied to a different statute. Bills sent to patients, and in most cases to health plan issuers without a governing contract, are subject to the 11 month rule under Civil Practice and Remedies Code Section 146.002. Claims submitted to a managed care carrier are subject to the 95 day rule under the Texas Insurance Code.
Frequently Asked Questions
What is the 11th month rule in Texas medical billing?
The 11th month rule, set by Civil Practice and Remedies Code Section 146.002, requires a provider to bill a patient or responsible person no later than the first day of the 11th month after the date services were provided. The same deadline applies to billing a health plan issuer or third party payor when no contract sets a different date.
What is the 95-day rule, and how does it differ from the 11th month rule?
The 95-day rule says a provider must send a claim to a managed care plan, like an HMO or PPO, within 95 days of when the care was given. This timing limit comes from the Texas Insurance Code. It is not the same source as the Civil Practice and Remedies Code. It also applies only when the claim is filed with a managed care carrier. If a bill is sent straight to a patient, this rule does not cover that situation.
What happens if a provider misses the timely billing deadline in Texas?
Under Section 146.003, a provider who misses the Chapter 146 deadline forfeits the right to collect from the patient any amount the patient’s health plan would have covered, or any amount the patient would not otherwise have owed. The same bar applies to family members who would otherwise be responsible for the patient’s debt. A missed 95 day deadline under the Insurance Code results in forfeiture of the right to payment from the managed care carrier.
Does missing the timely billing deadline affect a provider’s license?
No. Section 146.004 states that a violation of the timely billing requirement does not subject a provider to disciplinary action under any other law, including the law under which the provider is licensed. The consequence is limited to forfeiture of payment.
How does the 2025 amendment to Section 146.002 affect personal injury billing?
House Bill 4145, effective September 1, 2025, added Subsection (c-1) to Section 146.002. It allows a provider treating a patient represented by an attorney in a personal injury claim to satisfy the 11 month billing requirement by sending the bill to that attorney, rather than to the patient directly, unless the patient or responsible person specifies otherwise.
