Sec. 1452.151. DEFINITIONS. In this subchapter:
(1) "Applicant podiatrist" means a podiatrist applying for expedited credentialing under this subchapter.
(2) "Enrollee" means an individual who is eligible to receive health care services under a managed care plan.
(3) "Health care provider" means:
(A) an individual who is licensed, certified, or otherwise authorized to provide health care services in this state; or
(B) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services.
(4) "Managed care plan" means a health benefit plan under which health care services are provided to enrollees through contracts with health care providers and that requires enrollees to use participating providers or that provides a different level of coverage for enrollees who use participating providers. The term includes a health benefit plan issued by:
(A) a health maintenance organization;
(B) a preferred provider benefit plan issuer; or
(C) any other entity that issues a health benefit plan, including an insurance company.
(5) "Participating provider" means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.
(6) "Professional practice" means a business entity that is owned by one or more podiatrists or physicians.
Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.
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 D. Expedited Credentialing Process
Section 1452.152. Applicability
Section 1452.153. Eligibility Requirements
Section 1452.154. Payment of Applicant Podiatrist During Credentialing Process
Section 1452.155. Directory Entries
Section 1452.156. Effect of Failure to Meet Credentialing Requirements
Section 1452.157. Enrollee Held Harmless
Section 1452.158. Limitation on Managed Care Issuer Liability