Sec. 1272.053. MONITORING PLAN. A delegation agreement required by Section 1272.052 must establish a monitoring plan that:
(1) allows the health maintenance organization to monitor compliance with the minimum solvency requirements established under Subchapter D, if applicable; and
(2) includes:
(A) a description of financial practices that will ensure that the delegated entity tracks and reports liabilities that have been incurred but not reported;
(B) a summary of the total amount paid by the entity to physicians and providers on a monthly basis; and
(C) a summary of complaints from physicians, providers, and enrollees regarding delays in payment or nonpayment of claims, including the status of each complaint, on a monthly basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1272 - Delegation of Certain Functions by Health Maintenance Organization
Subchapter B. Delegation Agreements
Section 1272.051. Applicability of Subchapter
Section 1272.052. Delegation Agreement Required
Section 1272.053. Monitoring Plan
Section 1272.054. Requirements for Termination Without Cause
Section 1272.055. Collection of Payments
Section 1272.056. Compliance With Statutory and Regulatory Requirements
Section 1272.057. Examination by Commissioner
Section 1272.058. Information Relating to Delegated Third Party
Section 1272.059. Contracts With Delegated Third Party
Section 1272.060. Utilization Review
Section 1272.061. Rights and Duties of Delegated Entity and Health Maintenance Organization
Section 1272.062. Information to Be Provided by Delegated Entity to Health Maintenance Organization