Sec. 1301.1052. PREFERRED PROVIDER APPEAL AFTER AUDIT. If a preferred provider disagrees with a refund request made by an insurer based on an audit under Section 1301.105, the insurer shall provide the provider with an opportunity to appeal, and the insurer may not attempt to recover the payment until all appeal rights are exhausted.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.037(a), eff. September 1, 2005.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1301 - Preferred Provider Benefit Plans
Subchapter C. Prompt Payment of Claims
Section 1301.102. Submission of Claim
Section 1301.1021. Receipt of Claim
Section 1301.103. Deadline for Action on Clean Claims
Section 1301.104. Deadline for Action on Pharmacy Claims; Payment
Section 1301.105. Audited Claims
Section 1301.1051. Completion of Audit
Section 1301.1052. Preferred Provider Appeal After Audit
Section 1301.1053. Deadlines Not Extended
Section 1301.1054. Requests for Additional Information
Section 1301.106. Claims Processing Procedures and Claims Payment Processes
Section 1301.107. Contractual Waiver and Other Actions Prohibited
Section 1301.108. Attorney's Fees
Section 1301.109. Applicability to Entities Contracting With Insurer