TX HB3042

Requires persons providing laboratory claim integrity programs to register with the Texas Department of Insurance before operating in the state, with registrations valid for three years and renewable

Defines laboratory claim integrity programs as claim editing programs that identify wasteful clinical laboratory tests based on a health benefit plan's reimbursement policies

Exempts health benefit plan issuers and utilization review agents already registered under Chapter 4201 from the new registration requirement, and exempts laboratory claim integrity program activities from utilization review requirements

Prohibits laboratory claim integrity programs from requiring physicians to use specific clinical decision support software, restricting providers' choice of electronic health records or billing services, or making claim determinations on behalf of insurers

Specifies that claim denials or payment reductions resulting from laboratory claim integrity program reviews do not constitute adverse determinations subject to utilization review appeal processes, effective for contracts entered into or renewed on or after January 1, 2026