Sec. 843.351. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND PROVIDERS. The provisions of this subchapter relating to prompt payment by a health maintenance organization of a physician or provider and to verification of health care services apply to a physician or provider who:
(1) is not included in the health maintenance organization delivery network; and
(2) provides to an enrollee:
(A) care related to an emergency or its attendant episode of care as required by state or federal law; or
(B) specialty or other health care services at the request of the health maintenance organization or a physician or provider who is included in the health maintenance organization delivery network because the services are not reasonably available within the network.
Added by Acts 2003, 78th Leg., ch. 214, Sec. 19, eff. June 17, 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 J. Payment of Claims to Physicians and Providers
Section 843.337. Time for Submission of Claim; Duplicate Claims; Acknowledgment of Receipt of Claim
Section 843.338. Deadline for Action on Clean Claims
Section 843.3385. Additional Information
Section 843.339. Deadline for Action on Prescription Claims; Payment
Section 843.340. Audited Claims
Section 843.3405. Investigation and Determination of Payment
Section 843.341. Claims Processing Procedures
Section 843.342. Violation of Certain Claims Payment Provisions; Penalties
Section 843.343. Attorney's Fees
Section 843.346. Payment of Claims
Section 843.348. Preauthorization of Health Care Services
Section 843.3481. Posting of Preauthorization Requirements
Section 843.3483. Remedy for Noncompliance
Section 843.349. Coordination of Payment
Section 843.351. Services Provided by Certain Physicians and Providers
Section 843.352. Conflict With Other Law