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.Tex. Ins. Code § 1213.003
Added by Acts 2005, 79th Leg., Ch. 728, Sec. 11.029(a), eff. 9/1/2005.