Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM
Subchapter E - PROVIDER REQUIREMENTS
Section 370.453 - Balance Billing
Current through Reg. 49, No. 38; September 20, 2024
(a) A provider may only seek reimbursement from a CHIP managed care organization for a covered service provided to a CHIP member. A provider may not seek reimbursement or attempt to obtain payment from a CHIP member, the CHIP member's family, or the CHIP member's guardian for a covered service.
(b) The provisions of subsection (a) of this section apply to all covered services provided to a CHIP member, including emergency services provided by an out-of-network provider, in compliance with federal regulations (RSA 457.515(f)).
(c) The provisions of subsection (a) of this section do not apply to:
(d) Providers may not bill or take other recourse against the CHIP member, the CHIP member's family, or the CHIP member's guardian for claims denied as a result of error attributed to the provider or Claims Processing Entity.
(e) This rule applies to providers that participate in a CHIP managed care organization's network and out-of-network providers.
