Sec. 843.313. ECONOMIC PROFILING. (a) A health maintenance organization that conducts or uses economic profiling of physicians or providers participating in the health maintenance organization delivery network shall make available to a network physician or provider on request that physician's or provider's economic profile, including the standards by which the physician or provider is measured.
(b) The use of an economic profile must recognize the characteristics of a physician's or provider's practice that may account for variations from expected costs.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Structure Texas Statutes
Title 6 - Organization of Insurers and Related Entities
Subtitle C - Life, Health, and Accident Insurers and Related Entities
Chapter 843 - Health Maintenance Organizations
Subchapter I. Relations With Physicians and Providers
Section 843.301. Practice of Medicine Not Affected
Section 843.303. Denial of Initial Contract to Physician or Provider
Section 843.304. Exclusion of Provider Based on Type of License Prohibited
Section 843.3041. Acupuncturist Services
Section 843.3042. Chiropractic Services
Section 843.3045. Nurse First Assistant
Section 843.305. Annual Application Period for Physicians and Providers to Contract
Section 843.306. Termination of Participation; Advisory Review Panel
Section 843.307. Expedited Review Process on Termination or Deselection
Section 843.308. Notification of Patients of Deselected Physician or Provider
Section 843.310. Contracts With Physicians or Providers: Certain Indemnity Clauses Prohibited
Section 843.311. Contracts With Podiatrists
Section 843.3115. Contracts With Dentists
Section 843.312. Physician Assistants and Advanced Practice Nurses
Section 843.313. Economic Profiling
Section 843.314. Inducement to Limit Medically Necessary Services Prohibited
Section 843.315. Payment of Capitation; Assignment of Primary Care Physician or Provider
Section 843.316. Alternative Capitation System
Section 843.318. Certain Contracts of Participating Physician or Provider Not Prohibited
Section 843.319. Certain Required Contracts
Section 843.320. Use of Hospitalist
Section 843.321. Availability of Coding Guidelines
Section 843.323. Contract Provisions Prohibiting Rejection of Batched Claims