Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter T - SUBMISSION OF CLEAN CLAIMS
Section 21.2823 - Applicability to Certain Noncontracting Physicians and Providers
Current through Reg. 50, No. 13; March 28, 2025
The provisions of § 19.1719 of this title (relating to Verification for Health Maintenance Organizations and Preferred Provider Benefit Plans) and § 21.2807 of this title (relating to Effect of Filing a Clean Claim) apply to a physician or a provider that provides to an enrollee or an insured of an MCC:
(1) care related to an emergency or its attendant episode of care as required by state or federal law; or
(2) specialty or other medical care or health care services at the request of the MCC, the physician, or the provider because the services are not reasonably available from a physician or a provider who is included in the MCC's network.
