The Texas Timely Billing Law sets a strict deadline for when providers must bill patients. Under the law, a provider must send a bill no later than the first day of the 11th month after the date of service. Providers who miss this deadline can lose the right to collect certain charges.
The law sits in the Texas Civil Practice and Remedies Code, Chapter 146. Chapter 146 covers timely billing and the charges barred when a provider bills late. A separate rule requires providers to file insurance claims within 95 days of service.
This guide explains the Texas billing deadlines, the exceptions, and the consequences for late billing. The guide also covers patient billing, insurance claim filing, and related Texas billing laws.
What Is the Texas Timely Billing Law?
The Texas Timely Billing Law requires providers to bill patients no later than the first day of the 11th month after the date of service. The law appears in the Texas Civil Practice and Remedies Code, Chapter 146. Section 146.002 sets the billing deadline for patients and responsible parties.
Section 146.003 states the penalty for late billing under the law. A provider who violates Section 146.002 may not collect certain charges from the patient. The barred charges include amounts a health plan would have covered with timely billing. The rule applies to hospitals, clinics, physicians, and other health care service providers.
The table below shows the two core sections of the Texas Timely Billing Law:
| Section | What It Covers |
|---|---|
| Sec. 146.002 | Sets the timely billing deadline for patients and payers |
| Sec. 146.003 | Bars collection of certain charges after late billing |
Section 146.002 sets the deadline, and Section 146.003 sets what a provider loses by missing it.
What Are the Billing Deadlines Under Texas Law?
Texas law sets two main billing deadlines: 11 months to bill patients and 95 days to file insurance claims. Texas law gives providers two separate deadlines to track. One deadline governs billing the patient, and the other governs filing claims with insurers. Missing either deadline carries a different financial consequence for the provider.
How Long Do Providers Have to Bill a Patient?
Providers must bill a patient by the first day of the 11th month after the date of service. In practice, this leaves roughly 10 full months to send the bill. The clock starts on the date the provider delivers the service. The deadline applies to the patient and any other responsible person.
What Is the 95-Day Insurance Claim Filing Deadline?
Texas Insurance Code rules require providers to file clean claims within 95 days of service. Providers who file after 95 days generally forfeit the right to payment on those claims. Contracts can set a longer filing window, but not a shorter one. A catastrophic event that halts operations can pause the 95-day clock.
How Is the Billing Date Determined?
The law measures billing by the date the provider mails or submits the bill. Electronic submission and mailing both count as billing under the statute. Providers should keep dated records of every claim and patient statement. Dated proof helps a provider show the bill went out on time.
The table compares the two Texas billing deadlines:
| Deadline | Applies To | Time Limit | Penalty for Missing |
|---|---|---|---|
| Patient billing (Ch. 146) | Patient or responsible party | First day of the 11th month after service | Cannot collect barred charges from the patient |
| Insurance claim filing | Insurance carrier | 95 days from the date of service | Forfeit payment on the late claim |
Providers protect revenue by meeting the shorter 95-day insurer deadline well before the 11-month patient deadline.
What Are the Exceptions to the Texas Timely Billing Law?
The Texas Timely Billing Law allows exceptions for insurer contracts, third-party payer rules, and certain billing situations. The 11-month rule does not apply the same way in every case. Contracts and federal payer rules can change the deadline a provider must meet. Chapter 146 sets out these exceptions in subsections of Section 146.002.
Common exceptions to the Texas Timely Billing Law include:
- Direct billing to a health plan follows the deadline in the provider-insurer contract.
- Medicare and Medicaid claims follow the payer contract or federal timing rules.
- When no contract sets a deadline, the general 11-month rule applies.
- Coordination of benefits across multiple payers can affect the applicable deadline.
What Consequences Do Providers Face for Not Following the Texas Timely Billing Law?
Providers who violate the Texas Timely Billing Law lose the right to collect the barred charges from the patient. Late insurance claims also forfeit payment from the carrier. Separate Texas laws add penalties for improper or knowingly false billing. The main consequence is financial, through lost and uncollectable revenue.
Loss of the Right to Collect From Patients
Section 146.003 bars a provider from collecting certain charges after a late bill. The barred amount covers what a health plan would have paid with timely billing. The provider also cannot bill the patient for charges the patient would not otherwise owe. The provider cannot shift the barred charge to a family member either.
Does the Timely Billing Law Carry License Discipline?
Chapter 146 penalizes late billing through lost collection rights, not license action. A provider who bills late keeps their medical license under this law. The consequence is financial rather than professional for a simple late bill. Other Texas billing laws treat fraudulent billing far more harshly.
What Happens With Improper or Fraudulent Billing?
Texas Health and Safety Code Section 311.0025 bars billing for services a provider knows were not provided or were unnecessary. A licensing agency can audit the billing and patient records after a complaint. Violations can bring license denial, suspension, revocation, or nonrenewal. These penalties come on top of any civil, administrative, or criminal liability.
Can Providers Still Sue for Unpaid Bills?
Texas Civil Practice and Remedies Code Section 16.004 sets a four-year statute of limitations. A provider generally has four years from the date the debt accrues to file suit. Charges barred by late billing cannot be recovered through a lawsuit. Providers also must send an itemized bill before sending an account to collections.
The table summarizes the main consequences of late or improper billing in Texas:
| Violation | Governing Law | Consequence |
|---|---|---|
| Late patient billing | Ch. 146, Sec. 146.003 | Loss of the right to collect barred charges from the patient |
| Late insurance claim (over 95 days) | Texas Insurance Code rules | Forfeited payment from the carrier |
| Suing after four years | Sec. 16.004 | Time-barred, no legal recovery |
| Improper or false billing | Health & Safety Code 311.0025 | License discipline plus civil or criminal penalty |
Most late-billing losses hit revenue directly, while improper billing risks a provider’s license.
What Other Texas Billing Laws Should Providers Know?
Texas providers should also track the itemized-bill rule, surprise billing protections, and the statute of limitations. Several other Texas laws shape how providers bill patients and handle unpaid balances. These laws affect collections, out-of-network charges, and required patient statements. Each law works alongside the Texas Timely Billing Law.
Related Texas billing laws include:
- Itemized bill rule (Health and Safety Code Chapter 185): providers must send a plain-language itemized bill before collections.
- Statute of limitations (Section 16.004): providers have four years to sue for an unpaid debt.
- Surprise billing law (SB 1264) and the federal No Surprises Act: both limit balance billing for out-of-network care.
These rules overlap with billing deadlines and collection limits across the state. A detailed breakdown appears in this guide on Texas law on unpaid medical bills. Providers can read that guide for the debt collection and statute-of-limitations details.
How Can Providers Stay Compliant With the Texas Timely Billing Law?
Providers stay compliant by tracking service dates, filing claims within 95 days, and billing patients well before the 11-month deadline. Compliance starts with accurate records of every date of service. Providers who track dates can meet both the 95-day and 11-month deadlines. A clear billing workflow keeps claims and patient statements moving on time.
Providers can follow these steps to meet Texas billing deadlines:
- Record the date of service for every patient encounter.
- File clean insurance claims within 95 days of service.
- Send patient bills well before the first day of the 11th month.
- Send a plain-language itemized bill before any account goes to collections.
- Track accounts receivable and denials to catch delays early.
Busy practices often struggle to track every deadline alongside patient care. Many providers work with medical billing services in Texas to file claims and bill patients on time. A billing partner monitors deadlines, denials, and accounts receivable across payers.
