28 Tex. Admin. Code § 3.9805 - Express Authority
(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.
Notes
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