28 Tex. Admin. Code § 21.2823 - Applicability to Certain Noncontracting Physicians and Providers

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.

Notes

28 Tex. Admin. Code § 21.2823

The provisions of this §21.2823 adopted to be effective October 5, 2003, 28 TexReg 8647; amended to be effective February 16, 2014, 39 TexReg 747