The purpose of this subchapter is to:
(1) prescribe the process for requesting, initiating,
and conducting mandatory mediation and mandatory binding arbitration
of claims as authorized in Insurance Code Chapter 1467, concerning
Out-of-Network Claim Dispute Resolution;
(2) facilitate the process for the investigation and
review of a complaint filed with the department that relates to the
settlement of an out-of-network claim under Insurance Code Chapter
1467;
(3) prescribe the contents of the explanation of benefits
as required by Insurance Code §1271.008, concerning Balance Billing
Prohibition Notice; §1275.003, concerning Balance Billing Prohibition
Notice; §1301.010, concerning Balance Billing Prohibition Notice; §1551.015,
concerning Balance Billing Prohibition Notice; §1575.009, concerning
Balance Billing Prohibition Notice; and §1579.009, concerning
Balance Billing Prohibition Notice; and
(4) facilitate the collection of data as authorized
in Insurance Code §1467.006, concerning Benchmarking Database.
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| Source Note: The provisions of this §21.5001 adopted to be effective October 19, 2010, 35 TexReg 9300; amended to be effective November 3, 2016, 41 TexReg 8612; amended to be effective April 26, 2018, 43 TexReg 2423; amended to be effective December 23, 2019, 44 TexReg 7988; amended to be effective June 27, 2023, 48 TexReg 3409 |
