28 Tex. Admin. Code § 3.9801 - Definitions and General Provisions
(a) Terms
in this subchapter have the same meaning as defined and used in Insurance Code
Chapter 1458.
(b) The following
words and terms when used in this subchapter have the following meanings unless
the context clearly indicates otherwise:
(1)
Affiliate--Includes each person that is an affiliate under Insurance Code
Chapter 823.
(2) Fee
schedule--Includes payment or reimbursement terms of the provider network
contract.
(3) Primary provider
network--A provider network in which the contracting entity submitting the form
is the contracting entity for the provider network.
(4) Other provider network--A provider
network that may be accessed by the contracting entity submitting the form or
the submitting entity's affiliate, but in which the contracting entity for the
provider network is not an affiliate of the entity submitting the
form.
(5) Subsidiary provider
network--A provider network in which the contracting entity or entities for the
provider network are an affiliate of the entity submitting the form, except for
provider networks that also qualify as a primary provider network.
(6) TDI--Texas Department of
Insurance.
(c) In this
subchapter:
(1) the term "provider network
contracting entity" has the same meaning as contracting entity;
(2) a person begins acting as a contracting
entity in this state when the person enters into or offers to enter into direct
contracts with one or more providers for the delivery of health care services
to covered individuals that serve to create a provider network or networks to
be accessed by another party; and
(3) access to a provider network or networks
by another party includes access by an affiliate.
Notes
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