1 Tex. Admin. Code § 357.641 - Definitions

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Claim--An application for payment of health care services under Title XIX of the Social Security Act that is submitted by a person who is under a contract or provider agreement with DHS.

(2) Contract or provider agreement--Any written document (or series of documents) that obligates DHS or its health insuring agent to pay a person money under Title XIX of the Social Security Act in exchange for his goods or services. Included are claims for payment that a licensed practitioner (as defined by federal law) submits for services provided to Medicaid recipients.

(3) Commissioner--The commissioner of the Texas Department of Human Services.

(4) Days--Calendar days, unless otherwise specified.

(5) Department--The Texas Department of Human Services.

(6) Health insuring agent--An organization legally operating in the state that:

(A) pays providers of certain Title XIX medical services and supplies in exchange for premiums paid by DHS; and

(B) assumes an underwriting risk.

(7) Person--An individual, partnership, corporation, association, other organization, or legal entity that has a contract or provider agreement with DHS.

(8) Practitioner--A physician or other person licensed by the state to practice a profession.

(9) Provider--A person who has a contract or provider agreement with DHS.

(10) Title XIX--Title XIX of the Social Security Act.

Notes

1 Tex. Admin. Code § 357.641

The provisions of this §357.641 adopted to be effective May 16, 1988, 13 TexReg 1869; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9013