Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle F - Physicians and Health Care Providers

Section 1451.104. Nondiscriminatory Payment or Reimbursement; Exception - Sec. 1451.104. NONDISCRIMINATORY PAYMENT OR REIMBURSEMENT; EXCEPTION. (a) An insurer...

Section 1451.105. Selection of Acupuncturist - Sec. 1451.105. SELECTION OF ACUPUNCTURIST. An insured may select an...

Section 1451.106. Selection of Advanced Practice Nurse - Sec. 1451.106. SELECTION OF ADVANCED PRACTICE NURSE. An insured may...

Section 1451.107. Selection of Audiologist - Sec. 1451.107. SELECTION OF AUDIOLOGIST. An insured may select an...

Section 1451.108. Selection of Chemical Dependency Counselor - Sec. 1451.108. SELECTION OF CHEMICAL DEPENDENCY COUNSELOR. An insured may...

Section 1451.109. Selection of Chiropractor - Sec. 1451.109. SELECTION OF CHIROPRACTOR. (a) An insured may select...

Section 1451.110. Selection of Dentist - Sec. 1451.110. SELECTION OF DENTIST. An insured may select a...

Section 1451.111. Selection of Dietitian - Sec. 1451.111. SELECTION OF DIETITIAN. An insured may select a...

Section 1451.112. Selection of Hearing Instrument Fitter and Dispenser - Sec. 1451.112. SELECTION OF HEARING INSTRUMENT FITTER AND DISPENSER. An...

Section 1451.113. Selection of Licensed Clinical Social Worker - Sec. 1451.113. SELECTION OF LICENSED CLINICAL SOCIAL WORKER. An insured...

Section 1451.114. Selection of Licensed Professional Counselor - Sec. 1451.114. SELECTION OF LICENSED PROFESSIONAL COUNSELOR. An insured may...

Section 1451.115. Selection of Surgical Assistant - Sec. 1451.115. SELECTION OF SURGICAL ASSISTANT. An insured may select...

Section 1451.116. Selection of Marriage and Family Therapist - Sec. 1451.116. SELECTION OF MARRIAGE AND FAMILY THERAPIST. An insured...

Section 1451.117. Selection of Nurse First Assistant - Sec. 1451.117. SELECTION OF NURSE FIRST ASSISTANT. An insured may...

Section 1451.118. Selection of Occupational Therapist - Sec. 1451.118. SELECTION OF OCCUPATIONAL THERAPIST. An insured may select...

Section 1451.119. Selection of Optometrist - Sec. 1451.119. SELECTION OF OPTOMETRIST. An insured may select an...

Section 1451.120. Selection of Physical Therapist - Sec. 1451.120. SELECTION OF PHYSICAL THERAPIST. An insured may select...

Section 1451.121. Selection of Physician Assistant - Sec. 1451.121. SELECTION OF PHYSICIAN ASSISTANT. An insured may select...

Section 1451.122. Selection of Podiatrist - Sec. 1451.122. SELECTION OF PODIATRIST. An insured may select a...

Section 1451.123. Selection of Psychological Associate - Sec. 1451.123. SELECTION OF PSYCHOLOGICAL ASSOCIATE. An insured may select...

Section 1451.124. Selection of Psychologist - Sec. 1451.124. SELECTION OF PSYCHOLOGIST. An insured may select a...

Section 1451.125. Selection of Speech-Language Pathologist - Sec. 1451.125. SELECTION OF SPEECH-LANGUAGE PATHOLOGIST. An insured may select...

Section 1451.126. Reimbursement for Physical Modalities and Procedures by Health Insurer, Administrator, Health Maintenance Organization, or Preferred Provider Benefit Plan Issuer - Sec. 1451.126. REIMBURSEMENT FOR PHYSICAL MODALITIES AND PROCEDURES BY HEALTH...

Section 1451.1261. Reimbursement for Certain Services and Procedures Performed by Pharmacists - Sec. 1451.1261. REIMBURSEMENT FOR CERTAIN SERVICES AND PROCEDURES PERFORMED BY...

Section 1451.127. Duty of Person Arranging Provider Contracts for Health Insurer or Health Maintenance Organization - Sec. 1451.127. DUTY OF PERSON ARRANGING PROVIDER CONTRACTS FOR HEALTH...

Section 1451.128. Selection of Pharmacist - Sec. 1451.128. SELECTION OF PHARMACIST. An insured may select a...

Subchapter D. Access to Optometrists and Ophthalmologists Used Under Managed Care Plan

Section 1451.151. Definitions - Sec. 1451.151. DEFINITIONS. In this subchapter: (1) "Managed care plan"...

Section 1451.152. Applicability and Construction of Subchapter - Sec. 1451.152. APPLICABILITY AND CONSTRUCTION OF SUBCHAPTER. (a) This subchapter...

Section 1451.153. Use of Optometrist, Therapeutic Optometrist, or Ophthalmologist - Sec. 1451.153. USE OF OPTOMETRIST, THERAPEUTIC OPTOMETRIST, OR OPHTHALMOLOGIST. (a)...

Section 1451.154. Participation of Therapeutic Optometrist - Sec. 1451.154. PARTICIPATION OF THERAPEUTIC OPTOMETRIST. (a) In this section:...

Section 1451.155. Contracts With Optometrists or Therapeutic Optometrists - Sec. 1451.155. CONTRACTS WITH OPTOMETRISTS OR THERAPEUTIC OPTOMETRISTS. (a) In...

Section 1451.156. Prohibited Conduct - Sec. 1451.156. PROHIBITED CONDUCT. (a) A managed care plan, as...

Subchapter E. Dental Care Benefits in Health Insurance Policies or Employee Benefit Plans

Section 1451.201. Definitions - Sec. 1451.201. DEFINITIONS. In this subchapter: (1) "Dental care service"...

Section 1451.202. Applicability and Construction of Subchapter - Sec. 1451.202. APPLICABILITY AND CONSTRUCTION OF SUBCHAPTER. (a) This subchapter...

Section 1451.203. Conflicting Provisions - Sec. 1451.203. CONFLICTING PROVISIONS. A provision of an employee benefit...

Section 1451.204. Certain Conduct Permitted - Sec. 1451.204. CERTAIN CONDUCT PERMITTED. (a) Notwithstanding any other provision...

Section 1451.205. Disclosure of Benefit Terms - Sec. 1451.205. DISCLOSURE OF BENEFIT TERMS. (a) An employee benefit...

Section 1451.206. Payment or Reimbursement of Dentist - Sec. 1451.206. PAYMENT OR REIMBURSEMENT OF DENTIST. (a) The employee...

Section 1451.2065. Contracts With Dentists - Sec. 1451.2065. CONTRACTS WITH DENTISTS. (a) In this section, "covered...

Section 1451.207. Prohibited Conduct - Sec. 1451.207. PROHIBITED CONDUCT. (a) An employee benefit plan or...

Section 1451.208. Prior Authorization of Dental Care Services - Sec. 1451.208. PRIOR AUTHORIZATION OF DENTAL CARE SERVICES. (a) For...

Subchapter F. Access to Obstetrical or Gynecological Care

Section 1451.251. Definition - Sec. 1451.251. DEFINITION. In this subchapter, "enrollee" means an individual...

Section 1451.252. Applicability of Subchapter - Sec. 1451.252. APPLICABILITY OF SUBCHAPTER. This subchapter applies only to...

Section 1451.253. Exception - Sec. 1451.253. EXCEPTION. This subchapter does not apply to: (1)...

Section 1451.254. Rules - Sec. 1451.254. RULES. The commissioner shall adopt rules necessary to...

Section 1451.255. Right of Female Enrollee to Select Obstetrician or Gynecologist - Sec. 1451.255. RIGHT OF FEMALE ENROLLEE TO SELECT OBSTETRICIAN OR...

Section 1451.256. Direct Access to Services of Obstetrician or Gynecologist - Sec. 1451.256. DIRECT ACCESS TO SERVICES OF OBSTETRICIAN OR GYNECOLOGIST....

Section 1451.257. Availability of Providers - Sec. 1451.257. AVAILABILITY OF PROVIDERS. To ensure access to services...

Section 1451.258. Notice of Available Providers - Sec. 1451.258. NOTICE OF AVAILABLE PROVIDERS. (a) A health benefit...

Section 1451.259. Limits on Physician Sanctions - Sec. 1451.259. LIMITS ON PHYSICIAN SANCTIONS. (a) A health benefit...

Section 1451.260. Administrative Penalty - Sec. 1451.260. ADMINISTRATIVE PENALTY. An entity that operates a health...

Subchapter G. Access to Dietitian Services

Section 1451.301. Applicability of General Provisions of Other Law - Sec. 1451.301. APPLICABILITY OF GENERAL PROVISIONS OF OTHER LAW. The...

Section 1451.302. Dietitian Services - Sec. 1451.302. DIETITIAN SERVICES. An individual or group accident and...

Subchapter H. Disability Certified by Podiatrist

Section 1451.351. Loss of Income Benefits for Disability Treatable by Podiatrist - Sec. 1451.351. LOSS OF INCOME BENEFITS FOR DISABILITY TREATABLE BY...

Subchapter I. Use of Osteopathic Hospital

Section 1451.401. Contract With Osteopathic Hospital - Sec. 1451.401. CONTRACT WITH OSTEOPATHIC HOSPITAL. A health maintenance organization...

Section 1451.402. Services at Osteopathic Hospital - Sec. 1451.402. SERVICES AT OSTEOPATHIC HOSPITAL. A health maintenance organization...

Section 1451.403. Request for Action of Commissioner - Sec. 1451.403. REQUEST FOR ACTION OF COMMISSIONER. An aggrieved party...

Section 1451.404. Enforcement - Sec. 1451.404. ENFORCEMENT. The commissioner shall take all reasonable actions...

Subchapter J. Reimbursement of Health Care Providers

Section 1451.451. Reimbursement Under Medicaid-Based Fee Schedule - Sec. 1451.451. REIMBURSEMENT UNDER MEDICAID-BASED FEE SCHEDULE. (a) An insurance...

Subchapter K. Health Care Provider Directories

Section 1451.501. Definitions - Sec. 1451.501. DEFINITIONS. In this subchapter: (1) "Facility" has the...

Section 1451.502. Applicability of Subchapter - Sec. 1451.502. APPLICABILITY OF SUBCHAPTER. This subchapter applies only to...

Section 1451.503. Exception - Sec. 1451.503. EXCEPTION. This subchapter does not apply to: (1)...

Section 1451.504. Physician and Health Care Provider Directories - Sec. 1451.504. PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORIES. (a) A...

Section 1451.505. Physician and Health Care Provider Directory on Internet Website - Sec. 1451.505. PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORY ON INTERNET...

Chapter 1452 - Physician and Provider Credentials

Subchapter A. Credentialing of Physicians and Providers by Health Maintenance Organization

Section 1452.001. Applicability of Certain Definitions - Sec. 1452.001. APPLICABILITY OF CERTAIN DEFINITIONS. In this subchapter, a...

Section 1452.002. Verification of Physician's License or Certificate - Sec. 1452.002. VERIFICATION OF PHYSICIAN'S LICENSE OR CERTIFICATE. The commissioner...

Section 1452.003. Site Visit for Initial Credentialing - Sec. 1452.003. SITE VISIT FOR INITIAL CREDENTIALING. (a) The commissioner...

Section 1452.004. Limitation on Commissioner's Authority - Sec. 1452.004. LIMITATION ON COMMISSIONER'S AUTHORITY. The commissioner may not...

Section 1452.005. Site Visit for Cause Not Precluded - Sec. 1452.005. SITE VISIT FOR CAUSE NOT PRECLUDED. This subchapter...

Section 1452.006. Rules Related to Selection of Physicians and Providers by Health Maintenance Organization - Sec. 1452.006. RULES RELATED TO SELECTION OF PHYSICIANS AND PROVIDERS...

Subchapter B. Standardized Forms

Section 1452.051. Definitions - Sec. 1452.051. DEFINITIONS. In this subchapter: (1) "Advanced practice nurse"...

Section 1452.052. Standardized Form for Verification of Credentials - Sec. 1452.052. STANDARDIZED FORM FOR VERIFICATION OF CREDENTIALS. (a) The...

Subchapter C. Expedited Credentialing Process

Section 1452.101. Definitions - Sec. 1452.101. DEFINITIONS. In this subchapter: (1) "Applicant physician" means...

Section 1452.102. Applicability - Sec. 1452.102. APPLICABILITY. This subchapter applies only to a physician...

Section 1452.103. Eligibility Requirements - Sec. 1452.103. ELIGIBILITY REQUIREMENTS. To qualify for expedited credentialing under...

Section 1452.104. Payment of Applicant Physician During Credentialing Process - Sec. 1452.104. PAYMENT OF APPLICANT PHYSICIAN DURING CREDENTIALING PROCESS. On...

Section 1452.105. Directory Entries - Sec. 1452.105. DIRECTORY ENTRIES. Pending the approval of an application...

Section 1452.106. Effect of Failure to Meet Credentialing Requirements - Sec. 1452.106. EFFECT OF FAILURE TO MEET CREDENTIALING REQUIREMENTS. If,...

Section 1452.107. Enrollee Held Harmless - Sec. 1452.107. ENROLLEE HELD HARMLESS. An enrollee in the managed...

Section 1452.108. Limitation on Managed Care Issuer Liability - Sec. 1452.108. LIMITATION ON MANAGED CARE ISSUER LIABILITY. A managed...

Subchapter D. Expedited Credentialing Process

Section 1452.151. Definitions - Sec. 1452.151. DEFINITIONS. In this subchapter: (1) "Applicant podiatrist" means...

Section 1452.152. Applicability - Sec. 1452.152. APPLICABILITY. This subchapter applies only to a podiatrist...

Section 1452.153. Eligibility Requirements - Sec. 1452.153. ELIGIBILITY REQUIREMENTS. To qualify for expedited credentialing under...

Section 1452.154. Payment of Applicant Podiatrist During Credentialing Process - Sec. 1452.154. PAYMENT OF APPLICANT PODIATRIST DURING CREDENTIALING PROCESS. On...

Section 1452.155. Directory Entries - Sec. 1452.155. DIRECTORY ENTRIES. Pending the approval of an application...

Section 1452.156. Effect of Failure to Meet Credentialing Requirements - Sec. 1452.156. EFFECT OF FAILURE TO MEET CREDENTIALING REQUIREMENTS. If,...

Section 1452.157. Enrollee Held Harmless - Sec. 1452.157. ENROLLEE HELD HARMLESS. An enrollee in the managed...

Section 1452.158. Limitation on Managed Care Issuer Liability - Sec. 1452.158. LIMITATION ON MANAGED CARE ISSUER LIABILITY. A managed...

Subchapter E. Expedited Credentialing Process

Section 1452.201. Definitions - Sec. 1452.201. DEFINITIONS. In this subchapter: (1) "Applicant therapeutic optometrist"...

Section 1452.202. Applicability - Sec. 1452.202. APPLICABILITY. This subchapter applies only to a therapeutic...

Section 1452.203. Eligibility Requirements - Sec. 1452.203. ELIGIBILITY REQUIREMENTS. To qualify for expedited credentialing under...

Section 1452.204. Payment of Applicant Therapeutic Optometrist During Credentialing Process - Sec. 1452.204. PAYMENT OF APPLICANT THERAPEUTIC OPTOMETRIST DURING CREDENTIALING PROCESS....

Section 1452.205. Directory Entries - Sec. 1452.205. DIRECTORY ENTRIES. Pending the approval of an application...

Section 1452.206. Effect of Failure to Meet Credentialing Requirements - Sec. 1452.206. EFFECT OF FAILURE TO MEET CREDENTIALING REQUIREMENTS. If,...

Section 1452.207. Enrollee Held Harmless - Sec. 1452.207. ENROLLEE HELD HARMLESS. An enrollee in the managed...

Section 1452.208. Limitation on Managed Care Issuer Liability - Sec. 1452.208. LIMITATION ON MANAGED CARE ISSUER LIABILITY. A managed...

Chapter 1453 - Disclosure of Reimbursement Guidelines Under Managed Care Plan

Section 1453.001. Definitions - Sec. 1453.001. DEFINITIONS. In this chapter: (1) "Health care provider"...

Section 1453.002. Provision of Information Regarding Reimbursement Guidelines - Sec. 1453.002. PROVISION OF INFORMATION REGARDING REIMBURSEMENT GUIDELINES. (a) On...

Section 1453.003. Rules - Sec. 1453.003. RULES. The commissioner shall adopt rules as necessary...

Chapter 1454 - Equal Health Care for Women

Subchapter A. General Provisions

Section 1454.001. Definitions - Sec. 1454.001. DEFINITIONS. In this chapter: (1) "Health care provider"...

Section 1454.002. Applicability of Chapter - Sec. 1454.002. APPLICABILITY OF CHAPTER. This chapter applies only to...

Subchapter B. Reimbursement for Health Care Services

Section 1454.051. Equal Reimbursement Required - Sec. 1454.051. EQUAL REIMBURSEMENT REQUIRED. A health benefit plan issuer...

Section 1454.052. Reimbursement for Abortion Not Required - Sec. 1454.052. REIMBURSEMENT FOR ABORTION NOT REQUIRED. This chapter does...

Subchapter C. Enforcement

Section 1454.101. Sanctions Authorized - Sec. 1454.101. SANCTIONS AUTHORIZED. The sanctions authorized by Chapter 82...

Section 1454.102. Cease and Desist Procedures and Restitution for Attorney's Fees Authorized - Sec. 1454.102. CEASE AND DESIST PROCEDURES AND RESTITUTION FOR ATTORNEY'S...

Section 1454.103. Administrative Penalties Authorized - Sec. 1454.103. ADMINISTRATIVE PENALTIES AUTHORIZED. (a) In addition to any...

Section 1454.104. Amount of Damages - Sec. 1454.104. AMOUNT OF DAMAGES. Notwithstanding this subchapter, in imposing...

Section 1454.105. Applicability of Certain Procedural Requirements to Sanctions or Administrative Penalties - Sec. 1454.105. APPLICABILITY OF CERTAIN PROCEDURAL REQUIREMENTS TO SANCTIONS OR...

Section 1454.106. Intervention in Proceeding - Sec. 1454.106. INTERVENTION IN PROCEEDING. (a) In a proceeding relating...

Section 1454.107. Time for Commissioner's Determination - Sec. 1454.107. TIME FOR COMMISSIONER'S DETERMINATION. Not later than the...

Section 1454.108. Failure of Commissioner to Make Determination by Order; Action in District Court - Sec. 1454.108. FAILURE OF COMMISSIONER TO MAKE DETERMINATION BY ORDER;...

Section 1454.109. Appeal of Commissioner's Order - Sec. 1454.109. APPEAL OF COMMISSIONER'S ORDER. (a) A person affected...

Chapter 1455 - Telemedicine, Teledentistry, and Telehealth

Section 1455.001. Definitions - Sec. 1455.001. DEFINITIONS. In this chapter: (1) "Dentist" means a...

Section 1455.002. Applicability of Chapter - Sec. 1455.002. APPLICABILITY OF CHAPTER. This chapter applies only to...

Section 1455.003. Exception - Sec. 1455.003. EXCEPTION. This chapter does not apply to: (1)...

Section 1455.004. Coverage for Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services - Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES,...

Section 1455.005. Rules - Sec. 1455.005. RULES. Subject to Section 111.004, Occupations Code, the...

Section 1455.006. Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services Statement - Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH...

Chapter 1456 - Disclosure of Provider Status

Section 1456.001. Definitions - Sec. 1456.001. DEFINITIONS. In this chapter: (1) "Balance billing" means...

Section 1456.002. Applicability of Chapter - Sec. 1456.002. APPLICABILITY OF CHAPTER. (a) This chapter applies to...

Section 1456.003. Required Disclosure: Health Benefit Plan - Sec. 1456.003. REQUIRED DISCLOSURE: HEALTH BENEFIT PLAN. (a) Each health...

Section 1456.004. Required Disclosure: Facility-Based Physicians - Sec. 1456.004. REQUIRED DISCLOSURE: FACILITY-BASED PHYSICIANS. (a) If a facility-based...

Section 1456.005. Disciplinary Action and Administrative Penalty - Sec. 1456.005. DISCIPLINARY ACTION AND ADMINISTRATIVE PENALTY. (a) The commissioner...

Section 1456.006. Commissioner Rules; Form of Disclosure - Sec. 1456.006. COMMISSIONER RULES; FORM OF DISCLOSURE. The commissioner by...

Section 1456.007. Health Benefit Plan Estimate of Charges - Sec. 1456.007. HEALTH BENEFIT PLAN ESTIMATE OF CHARGES. A health...

Chapter 1457 - Provisional Credentialing Status

Section 1457.001. Definitions - Sec. 1457.001. DEFINITIONS. In this chapter: (1) "Enrollee" means an...

Section 1457.002. Provisional Credentialing Status - Sec. 1457.002. PROVISIONAL CREDENTIALING STATUS. (a) A health benefit plan...

Chapter 1458 - Provider Network Contract Arrangements

Subchapter A. General Provisions

Section 1458.001. General Definitions - Sec. 1458.001. GENERAL DEFINITIONS. In this chapter: (1) "Affiliate" means...

Section 1458.002. Definition of Health Benefit Plan - Sec. 1458.002. DEFINITION OF HEALTH BENEFIT PLAN. (a) In this...

Section 1458.003. Exemptions - Sec. 1458.003. EXEMPTIONS. This chapter does not apply: (1) under...

Section 1458.004. Rulemaking Authority - Sec. 1458.004. RULEMAKING AUTHORITY. The commissioner may adopt rules to...

Subchapter B. Registration Requirements

Section 1458.051. Registration Required - Sec. 1458.051. REGISTRATION REQUIRED. (a) Unless the person holds a...

Section 1458.052. Disclosure of Information - Sec. 1458.052. DISCLOSURE OF INFORMATION. (a) A person required to...

Section 1458.053. Submission of Information - Sec. 1458.053. SUBMISSION OF INFORMATION. Information required under this subchapter...

Section 1458.054. Fees - Sec. 1458.054. FEES. The department may collect a reasonable fee...

Section 1458.055. Exemption for Affiliates - Sec. 1458.055. EXEMPTION FOR AFFILIATES. (a) The commissioner shall grant...

Subchapter C. Rights and Responsibilities of a Contracting Entity

Section 1458.101. Contract Requirements - Sec. 1458.101. CONTRACT REQUIREMENTS. (a) In this section, the following...

Section 1458.102. Contract Access - Sec. 1458.102. CONTRACT ACCESS. (a) A contracting entity may not...

Section 1458.103. Enforcement - Sec. 1458.103. ENFORCEMENT. The commissioner may impose a sanction under...

Chapter 1460 - Standards Required Regarding Certain Physician Rankings by Health Benefit Plans

Section 1460.001. Definitions - Sec. 1460.001. DEFINITIONS. In this chapter: (1) "Health benefit plan...

Section 1460.002. Exemption - Sec. 1460.002. EXEMPTION. This chapter does not apply to: (1)...

Section 1460.003. Physician Ranking Requirements - Sec. 1460.003. PHYSICIAN RANKING REQUIREMENTS. (a) A health benefit plan...

Section 1460.004. Duties of Physicians - Sec. 1460.004. DUTIES OF PHYSICIANS. A physician may not require...

Section 1460.005. Rules; Standards - Sec. 1460.005. RULES; STANDARDS. (a) The commissioner shall adopt rules...

Section 1460.006. Duties of Health Benefit Plan Issuer - Sec. 1460.006. DUTIES OF HEALTH BENEFIT PLAN ISSUER. A health...

Section 1460.007. Sanctions; Disciplinary Actions - Sec. 1460.007. SANCTIONS; DISCIPLINARY ACTIONS. (a) A health benefit plan...

Chapter 1461 - Discrimination Against Physician Based on Maintenance of Certification

Section 1461.001. Definitions - Sec. 1461.001. DEFINITIONS. In this chapter: (1) "Enrollee" means an...

Section 1461.002. Applicability - Sec. 1461.002. APPLICABILITY. (a) This chapter applies to a physician...

Section 1461.003. Discrimination Based on Maintenance of Certification - Sec. 1461.003. DISCRIMINATION BASED ON MAINTENANCE OF CERTIFICATION. (a) Except...

Chapter 1467 - Out-of-Network Claim Dispute Resolution

Subchapter A. General Provisions

Section 1467.001. Definitions - Sec. 1467.001. DEFINITIONS. In this chapter: (1) "Administrator" means: (A)...

Section 1467.002. Applicability of Chapter - Sec. 1467.002. APPLICABILITY OF CHAPTER. This chapter applies to: (1)...

Section 1467.003. Rules - Sec. 1467.003. RULES. (a) The commissioner, the Texas Medical Board,...

Section 1467.004. Remedies Not Exclusive - Sec. 1467.004. REMEDIES NOT EXCLUSIVE. The remedies provided by this...

Section 1467.005. Reform - Sec. 1467.005. REFORM. This chapter may not be construed to...

Section 1467.006. Benchmarking Database - Sec. 1467.006. BENCHMARKING DATABASE. (a) In this section, "geozip area"...

Subchapter B. Mandatory Mediation for Out-of-Network Facilities

Section 1467.050. Applicability of Subchapter - Sec. 1467.050. APPLICABILITY OF SUBCHAPTER. (a) This subchapter applies only...

Section 1467.0505. Establishment and Administration of Mediation Program - Sec. 1467.0505. ESTABLISHMENT AND ADMINISTRATION OF MEDIATION PROGRAM. (a) The...

Section 1467.051. Availability of Mandatory Mediation - Sec. 1467.051. AVAILABILITY OF MANDATORY MEDIATION. (a) An out-of-network provider...

Section 1467.052. Mediator Qualifications - Sec. 1467.052. MEDIATOR QUALIFICATIONS. (a) Except as provided by Subsection...

Section 1467.053. Appointment of Mediator; Fees - Sec. 1467.053. APPOINTMENT OF MEDIATOR; FEES. (a) A mediation shall...

Section 1467.054. Request and Preliminary Procedures for Mandatory Mediation - Sec. 1467.054. REQUEST AND PRELIMINARY PROCEDURES FOR MANDATORY MEDIATION. (a)...

Section 1467.055. Conduct of Mediation; Confidentiality - Sec. 1467.055. CONDUCT OF MEDIATION; CONFIDENTIALITY. (a) A mediator may...

Section 1467.056. Matters Considered in Mediation; Agreed Resolution - Sec. 1467.056. MATTERS CONSIDERED IN MEDIATION; AGREED RESOLUTION. (a) In...

Section 1467.0575. Right to File Action - Sec. 1467.0575. RIGHT TO FILE ACTION. Not later than the...

Section 1467.060. Report of Mediator - Sec. 1467.060. REPORT OF MEDIATOR. Not later than the 45th...

Subchapter B. -1. Mandatory Binding Arbitration for Other Providers

Section 1467.081. Applicability of Subchapter - Sec. 1467.081. APPLICABILITY OF SUBCHAPTER. This subchapter applies only with...

Section 1467.082. Establishment and Administration of Arbitration Program - Sec. 1467.082. ESTABLISHMENT AND ADMINISTRATION OF ARBITRATION PROGRAM. (a) The...

Section 1467.083. Issue to Be Addressed; Basis for Determination - Sec. 1467.083. ISSUE TO BE ADDRESSED; BASIS FOR DETERMINATION. (a)...

Section 1467.084. Availability of Mandatory Arbitration - Sec. 1467.084. AVAILABILITY OF MANDATORY ARBITRATION. (a) Not later than...

Section 1467.085. Effect of Arbitration and Applicability of Other Law - Sec. 1467.085. EFFECT OF ARBITRATION AND APPLICABILITY OF OTHER LAW....

Section 1467.086. Selection and Approval of Arbitrator - Sec. 1467.086. SELECTION AND APPROVAL OF ARBITRATOR. (a) If the...

Section 1467.087. Procedures - Sec. 1467.087. PROCEDURES. (a) The arbitrator shall set a date...

Section 1467.088. Decision - Sec. 1467.088. DECISION. (a) Not later than the 51st day...

Section 1467.089. Effect of Decision - Sec. 1467.089. EFFECT OF DECISION. (a) An arbitrator's decision under...

Subchapter C. Bad Faith Participation

Section 1467.101. Bad Faith - Sec. 1467.101. BAD FAITH. (a) The following conduct constitutes bad...

Section 1467.102. Penalties - Sec. 1467.102. PENALTIES. (a) Bad faith participation or otherwise failing...

Subchapter D. Complaints; Consumer Protection

Section 1467.151. Consumer Protection; Rules - Sec. 1467.151. CONSUMER PROTECTION; RULES. (a) The commissioner and the...

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Texas Statutes Title 8 - Health Insurance and Other Health Coverages Subtitle F - Physicians and Health Care Providers

Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle F - Physicians and Health Care Providers