TX SB1616

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 payment recovery audits for equipment, supplies, or services that were previously granted prior authorization

Prevents managed care organizations from reviewing documentation errors in claims for previously approved items if the error was not made by the provider

Expands recovery audit contractor program to explicitly cover underpayments and overpayments under the Medicaid managed care program in addition to traditional Medicaid

Takes effect September 1, 2025, with provisions allowing delayed implementation if federal waivers or authorizations are required