TX HB159

Requires managed care organizations to provide all providers (not just those using electronic visit verification) a minimum of 60 days after exhausting appeal rights to cure claim defects before overpayment collection efforts can begin

Prohibits managed care organizations from reviewing medical necessity determinations during audits for equipment, supplies, or services that already received prior authorization

Prohibits managed care organizations from reviewing claim documentation errors for previously approved items if the error was not made by the provider

Expands recovery audit contractor programs to explicitly include identification of underpayments and overpayments under the Medicaid managed care program

Takes effect September 1, 2025, with implementation potentially delayed if federal waiver or authorization is required