Tex.
Ins. Code Section 1467.088
Decision
(a)
Not later than the 51st day after the date the arbitration is requested, an arbitrator shall provide the parties with a written decision in which the arbitrator:(1)
determines whether the billed charge or the payment made by the health benefit plan issuer or administrator, as those amounts were last modified during the issuer’s or administrator’s internal appeal process, if the provider elects to participate, or the informal settlement teleconference required by Section 1467.084 (Availability of Mandatory Arbitration)(d), as applicable, is the closest to the reasonable amount for the services or supplies determined in accordance with Section 1467.083 (Issue to Be Addressed; Basis for Determination)(b); and(2)
selects the amount determined to be closest under Subdivision (1) as the binding award amount.(b)
An arbitrator may not modify the binding award amount selected under Subsection (a).(c)
An arbitrator shall provide written notice in the form and manner prescribed by commissioner rule of the reasonable amount for the services or supplies and the binding award amount. If the parties settle before a decision, the parties shall provide written notice in the form and manner prescribed by commissioner rule of the amount of the settlement. The department shall maintain a record of notices provided under this subsection.
Source:
Section 1467.088 — Decision, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1467.htm#1467.088 (accessed May 18, 2024).
