{"id":47710,"date":"2026-09-04T15:58:47","date_gmt":"2026-09-04T15:58:47","guid":{"rendered":"https:\/\/vigilantbillingms.us\/staging\/staging\/?p=47710"},"modified":"2026-09-10T10:49:37","modified_gmt":"2026-09-10T10:49:37","slug":"texas-timely-billing-law-chapter-146-and-the-95-day-rule","status":"publish","type":"post","link":"https:\/\/vigilantbillingms.us\/staging\/medical-billing\/texas-timely-billing-law-chapter-146-and-the-95-day-rule\/","title":{"rendered":"Texas Timely Billing Law: Chapter 146 and the 95 Day Rule"},"content":{"rendered":"\t\t
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Texas Timely Billing Law: A Guide to Chapter 146 and the 95 Day Rule\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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In Texas, \u201ctimely billing\u201d 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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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What Counts as Timely Billing in Texas\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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The 11th Month Rule Under Section 146.002\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Billing the Patient Directly\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Billing a Health Plan Issuer or Third Party Payor\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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How the Date of Billing Is Determined\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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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\u2019s attorney. The mailing address must be the one listed in the provider\u2019s 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.\u00a0<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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The 2025 Personal Injury Billing Amendment\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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The 95 Day Rule for Managed Care Claims\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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When the 95 Day Clock Starts\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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  • For most claims, the count begins on the date the service was delivered.<\/span><\/li>
  • For an institutional provider, such as a hospital, the count does not begin until the date of the patient’s discharge.<\/span><\/li>
  • For a secondary claim involving coordination of benefits, the 95 day period does not begin until the provider receives the primary payor’s determination.<\/span><\/li><\/ul>

    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.<\/span><\/p>

    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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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    Chapter 146 or the 95 Day Rule: Which Deadline Applies\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    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.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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