Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
Subchapter QQ - PROVIDER NETWORK CONTRACT REGISTRATION
Section 3.9805 - Express Authority

Universal Citation: 28 TX Admin Code § 3.9805

Current through Reg. 50, No. 13; March 28, 2025

(a) Except as provided in subsection (c) of this section, the grant of express authority of a provider for access to their fee schedules cannot be presumed for any line of business for the purposes of compliance with Insurance Code § 1458.101.

(b) The contracting entity must notify the provider about all applicable fee schedules, but such notification is not to be, and must not be, construed as:

(1) prohibiting a provider network contracting entity from only contracting with providers who agree to all fee schedules; or

(2) requiring providers to agree to all fee schedules.

(c) For purposes of compliance with Insurance Code § 1458.101, a provider's express authority is presumed if:

(1) the provider network contract is in existence before September 1, 2013;

(2) on the first renewal after September 1, 2013, the contracting entity sends a written renewal notice by United States mail to the provider;

(3) the notice described by paragraph (2) of this subsection:
(A) contains a statement that failure to timely respond serves as assent to the renewal;

(B) contains separate signature lines for each line of business applicable to the contract; and

(C) specifies the separate fee schedule for each line of business applicable to the contract, described in any reasonable manner and which may be provided electronically; and

(4) the provider fails to respond within 60 days of receipt of the notice and has not objected to the renewal.

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