Journal of the House of Representatives of the Regular Session of the Eightieth Legislature of the State of Texas, Volume 6 Page: 6,477
6459-7408, S49-S79 p. ; 23 cm.View a full description of this legislative document.
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(2) "Enrollee" means an individual who is eligible to receive health
care services under a managed care plan.
(3) "Health care provider" means:
(A) an individual who is licensed, certified, or otherwise authorized
to provide health care services in this state; or
(B) a hospital, emergency clinic, outpatient clinic, or other facility
providing health care services.
(4) "Managed care plan" means a health benefit plan under which
health care services are provided to enrollees through contracts with health care
providers and that requires enrollees to use participating providers or that
provides a different level of coverage for enrollees who use participating
providers. The term includes a health benefit plan issued by:
(A) a health maintenance organization;
(B) a preferred provider benefit plan issuer; or
(C) any other entity that issues a health benefit plan, including an
insurance company.
(5) "Medical group" means a professional corporation or other business
entity composed of licensed physicians as permitted under Subchapter B, Chapter
162, Occupations Code.
(6) "Participating provider" means a health care provider who has
contracted with a health benefit plan issuer to provide services to enrollees.
Sec. 1452.102. APPLICABILITY. This subchapter applies only to a
physician who joins an established medical group that has a current contract in
force with a managed care plan.
Sec. 1452.103. ELIGIBILITY REQUIREMENTS. To qualify for expedited
credentialing under this subchapter and payment under Section 1452.104, an
applicant physician must:
(1) be licensed in this state by, and in good standing with, the Texas
Medical Board;
(2) submit all documentation and other information required by the
issuer of the managed care plan as necessary to enable the issuer to begin the
credentialing process required by the issuer to include a physician in the issuer's
health benefit plan network; and
(3) agree to comply with the terms of the managed care plan's
participating provider contract currently in force with the applicant physician's
established medical group.
Sec. 1452.104. PAYMENT OF APPLICANT PHYSICIAN DURING
CREDENTIALING PROCESS. On submission by the applicant physician of the
information required by the managed care plan issuer under Section 1452.103(2),
and for payment purposes only, the issuer shall treat the applicant physician as if
the physician were a participating provider in the health benefit plan network
when the applicant physician provides services to the managed care plan's
enrollees, including:
(1) authorizing the applicant physician to collect copayments from the
enrollees; and
(2) making payments to the applicant physician.Saturday, May 26, 2007
HOUSE JOURNAL
85th Day 6477
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Texas. Legislature. House of Representatives. Journal of the House of Representatives of the Regular Session of the Eightieth Legislature of the State of Texas, Volume 6, legislative document, 2007; (https://texashistory.unt.edu/ark:/67531/metapth97476/m1/23/: accessed April 28, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.