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.
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