Electronic Submission of Claims: Waiver

Sec. 1213.003. ELECTRONIC SUBMISSION OF CLAIMS: WAIVER. (a) A contract between the issuer of a health benefit plan and a health care professional or health care facility must provide for a waiver of any requirement for electronic submission established under this chapter. (b) The commissioner shall establish circumstances under which a waiver is required, including: (1) circumstances in which no method is available for the submission of claims in electronic form; (2) the operation of small physician practices; (3) the operation of other small health care provider practices; (4) undue hardship, including fiscal or operational hardship; or (5) any other special circumstance that would justify a waiver. (c) Any health care professional or health care facility that is denied a waiver by the issuer of a health benefit plan may appeal the denial to the commissioner. The commissioner shall determine whether a waiver must be granted. (d) The issuer of a health benefit plan may not refuse to contract or renew a contract with a health care professional or health care facility based in whole or in part on the professional or facility requesting or receiving a waiver or appealing a waiver determination. Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.