Tex. Ins. Code Section 1213.003
Electronic Submission of Claims: Waiver

(a)

A contract between the issuer of a health benefit plan and a health care professional or health care facility must provide for a waiver of any requirement for electronic submission established under this chapter.

(b)

The commissioner shall establish circumstances under which a waiver is required, including:

(1)

circumstances in which no method is available for the submission of claims in electronic form;

(2)

the operation of small physician practices;

(3)

the operation of other small health care provider practices;

(4)

undue hardship, including fiscal or operational hardship; or

(5)

any other special circumstance that would justify a waiver.

(c)

Any health care professional or health care facility that is denied a waiver by the issuer of a health benefit plan may appeal the denial to the commissioner. The commissioner shall determine whether a waiver must be granted.

(d)

The issuer of a health benefit plan may not refuse to contract or renew a contract with a health care professional or health care facility based in whole or in part on the professional or facility requesting or receiving a waiver or appealing a waiver determination.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.

Source: Section 1213.003 — Electronic Submission of Claims: Waiver, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1213.­htm#1213.­003 (accessed May 18, 2024).

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Accessed:
May 18, 2024

§ 1213.003’s source at texas​.gov