The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) Claim--An application for payment of health care services under Title XIX of the Social Security Act that is submitted by a person who is under a contract or provider agreement with DHS. (2) Contract or provider agreement--Any written document (or series of documents) that obligates DHS or its health insuring agent to pay a person money under Title XIX of the Social Security Act in exchange for his goods or services. Included are claims for payment that a licensed practitioner (as defined by federal law) submits for services provided to Medicaid recipients. (3) Commissioner--The commissioner of the Texas Department of Human Services. (4) Days--Calendar days, unless otherwise specified. (5) Department--The Texas Department of Human Services. (6) Health insuring agent--An organization legally operating in the state that: (A) pays providers of certain Title XIX medical services and supplies in exchange for premiums paid by DHS; and (B) assumes an underwriting risk. (7) Person--An individual, partnership, corporation, association, other organization, or legal entity that has a contract or provider agreement with DHS. (8) Practitioner--A physician or other person licensed by the state to practice a profession. (9) Provider--A person who has a contract or provider agreement with DHS. (10) Title XIX--Title XIX of the Social Security Act. |
| Source Note: The provisions of this §357.641 adopted to be effective May 16, 1988, 13 TexReg 1869; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9013 |
