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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle D. PROVIDER PLANS |
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Chapter 1301. PREFERRED PROVIDER BENEFIT PLANS |
| Subchapter A. GENERAL PROVISIONS |
| § 1301.001. DEFINITIONS |
| § 1301.002. NONAPPLICABILITY TO DENTAL CARE BENEFITS |
| § 1301.003. PREFERRED PROVIDER BENEFIT PLANS AND EXCLUSIVE PROVIDER BENEFIT PLANS PERMITTED |
| § 1301.0041. APPLICABILITY |
| § 1301.0042. APPLICABILITY OF INSURANCE LAW |
| § 1301.0045. CONSTRUCTION OF CHAPTER |
| § 1301.0046. COINSURANCE REQUIREMENTS FOR SERVICES OF NONPREFERRED PROVIDERS |
| § 1301.005. AVAILABILITY OF PREFERRED PROVIDERS |
| § 1301.0051. EXCLUSIVE PROVIDER BENEFIT PLANS: QUALITY IMPROVEMENT AND UTILIZATION MANAGEMENT |
| § 1301.0052. EXCLUSIVE PROVIDER BENEFIT PLANS: REFERRALS FOR MEDICALLY NECESSARY SERVICES |
| § 1301.0053. EXCLUSIVE PROVIDER BENEFIT PLANS: EMERGENCY CARE |
| § 1301.0055. NETWORK ADEQUACY STANDARDS |
| § 1301.0056. EXAMINATIONS AND FEES |
| § 1301.006. AVAILABILITY OF AND ACCESSIBILITY TO HEALTH CARE SERVICES |
| § 1301.0061. TERMS OF ENROLLEE ELIGIBILITY |
| § 1301.007. RULES |
| § 1301.008. CONFLICT WITH OTHER LAW |
| § 1301.009. ANNUAL REPORT |
| Subchapter B. RELATIONS WITH PHYSICIANS OR HEALTH CARE PROVIDERS |
| § 1301.051. DESIGNATION AS PREFERRED PROVIDER |
| § 1301.0515. ACUPUNCTURIST SERVICES |
| § 1301.052. DESIGNATION OF ADVANCED PRACTICE NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER |
| § 1301.0521. DESIGNATION OF CERTAIN PODIATRISTS AS PREFERRED PROVIDERS |
| § 1301.053. APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER |
| § 1301.054. NOTICE TO PRACTITIONERS OF PREFERRED PROVIDER BENEFIT PLAN |
| § 1301.055. COMPLAINT RESOLUTION |
| § 1301.056. RESTRICTIONS ON PAYMENT AND REIMBURSEMENT |
| § 1301.057. TERMINATION OF PARTICIPATION; EXPEDITED REVIEW PROCESS |
| § 1301.058. ECONOMIC PROFILING |
| § 1301.059. QUALITY ASSESSMENT |
| § 1301.060. COMPENSATION ON DISCOUNTED FEE BASIS |
| § 1301.061. PREFERRED PROVIDER NETWORKS |
| § 1301.062. PREFERRED PROVIDER CONTRACTS BETWEEN INSURERS AND PODIATRISTS |
| § 1301.0625. HEALTH CARE COLLABORATIVES |
| § 1301.063. CONTRACT PROVISIONS RELATING TO USE OF HOSPITALIST |
| § 1301.064. CONTRACT PROVISIONS RELATING TO PAYMENT OF CLAIMS |
| § 1301.0641. CONTRACT PROVISIONS PROHIBITING REJECTION OF BATCHED CLAIMS |
| § 1301.065. SHIFTING OF INSURER'S TORT LIABILITY PROHIBITED |
| § 1301.066. RETALIATION AGAINST PREFERRED PROVIDER PROHIBITED |
| § 1301.067. INTERFERENCE WITH RELATIONSHIP BETWEEN PATIENT AND PHYSICIAN OR HEALTH CARE PROVIDER PROHIBITED |
| § 1301.068. INDUCEMENT TO LIMIT MEDICALLY NECESSARY SERVICES PROHIBITED |
| § 1301.069. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND HEALTH CARE PROVIDERS |
| Subchapter C. PROMPT PAYMENT OF CLAIMS |
| § 1301.101. DEFINITION |
| § 1301.102. SUBMISSION OF CLAIM |
| § 1301.1021. RECEIPT OF CLAIM |
| § 1301.103. DEADLINE FOR ACTION ON CLEAN CLAIMS |
| § 1301.104. DEADLINE FOR ACTION ON PHARMACY CLAIMS; PAYMENT |
| § 1301.1041. AUDIT OF PHARMACIST OR PHARMACY |
| § 1301.105. AUDITED CLAIMS |
| § 1301.1051. COMPLETION OF AUDIT |
| § 1301.1052. PREFERRED PROVIDER APPEAL AFTER AUDIT |
| § 1301.1053. DEADLINES NOT EXTENDED |
| § 1301.1054. REQUESTS FOR ADDITIONAL INFORMATION |
| § 1301.106. CLAIMS PROCESSING PROCEDURES AND CLAIMS PAYMENT PROCESSES |
| § 1301.107. CONTRACTUAL WAIVER AND OTHER ACTIONS PROHIBITED |
| § 1301.108. ATTORNEY'S FEES |
| § 1301.109. APPLICABILITY TO ENTITIES CONTRACTING WITH INSURER |
| Subchapter C-1. OTHER PROVISIONS RELATING TO PAYMENT OF CLAIMS |
| § 1301.131. ELEMENTS OF CLEAN CLAIM |
| § 1301.132. OVERPAYMENT |
| § 1301.133. VERIFICATION |
| § 1301.134. COORDINATION OF PAYMENT |
| § 1301.135. PREAUTHORIZATION OF MEDICAL AND HEALTH CARE SERVICES |
| § 1301.136. AVAILABILITY OF CODING GUIDELINES |
| § 1301.137. VIOLATION OF CLAIMS PAYMENT REQUIREMENTS; PENALTY |
| § 1301.138. APPLICABILITY TO ENTITIES CONTRACTING WITH INSURER |
| § 1301.139. LEGISLATIVE DECLARATION |
| Subchapter D. RELATIONS BETWEEN INSUREDS AND PREFERRED PROVIDERS |
| § 1301.151. INSURED'S RIGHT TO TREATMENT |
| § 1301.152. CONTINUING CARE IN GENERAL |
| § 1301.153. CONTINUITY OF CARE |
| § 1301.154. OBLIGATION FOR CONTINUITY OF CARE OF INSURER |
| § 1301.155. EMERGENCY CARE |
| § 1301.156. PAYMENT OF CLAIMS TO INSURED |
| § 1301.157. PLAIN LANGUAGE REQUIREMENTS |
| § 1301.158. INFORMATION CONCERNING PREFERRED PROVIDER BENEFIT PLANS |
| § 1301.1581. INFORMATION CONCERNING EXCLUSIVE PROVIDER BENEFIT PLANS |
| § 1301.159. ANNUAL LIST OF PREFERRED PROVIDERS |
| § 1301.1591. PREFERRED PROVIDER INFORMATION ON INTERNET |
| § 1301.160. NOTIFICATION OF TERMINATION OF PARTICIPATION OF PREFERRED PROVIDER |
| § 1301.161. RETALIATION AGAINST INSURED PROHIBITED |
| § 1301.162. IDENTIFICATION CARD |
| § 1301.163. APPLICABILITY OF SUBCHAPTER TO ENTITIES CONTRACTING WITH INSURER |
| Subchapter E. CERTAIN HEALTH CARE PROVIDERS |
| § 1301.201. CONTRACTS WITH AND REIMBURSEMENT FOR NURSE FIRST ASSISTANTS |
| § 1301.202. CONTRACTS WITH HOSPITALS |