Sec. 1452.106. EFFECT OF FAILURE TO MEET CREDENTIALING REQUIREMENTS. If, on completion of the credentialing process, the managed care plan issuer determines that the applicant physician does not meet the issuer's credentialing requirements:
(1) the managed care plan issuer may recover from the applicant physician or the physician's medical group an amount equal to the difference between payments for in-network benefits and out-of-network benefits; and
(2) the applicant physician or the physician's medical group may retain any copayments collected or in the process of being collected as of the date of the issuer's determination.
Added by Acts 2007, 80th Leg., R.S., Ch. 1203 (H.B. 1594), Sec. 1, eff. September 1, 2007.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle F - Physicians and Health Care Providers
Chapter 1452 - Physician and Provider Credentials
Subchapter C. Expedited Credentialing Process
Section 1452.102. Applicability
Section 1452.103. Eligibility Requirements
Section 1452.104. Payment of Applicant Physician During Credentialing Process
Section 1452.105. Directory Entries
Section 1452.106. Effect of Failure to Meet Credentialing Requirements
Section 1452.107. Enrollee Held Harmless
Section 1452.108. Limitation on Managed Care Issuer Liability