Sec. 1301.109. APPLICABILITY TO ENTITIES CONTRACTING WITH INSURER. This subchapter applies to a person, including a pharmacy benefit manager, with whom an insurer contracts to:
(1) process or pay claims;
(2) obtain the services of physicians and health care providers to provide health care services to insureds; or
(3) issue verifications or preauthorizations.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.037(a), eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 798 (H.B. 2292), Sec. 11, eff. September 1, 2011.
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