Sec. 1467.001. DEFINITIONS. In this chapter:
(1) "Administrator" means:
(A) an administering firm for a health benefit plan providing coverage under Chapter 1551; and
(B) if applicable, the claims administrator for the health benefit plan.
(2) "Chief administrative law judge" means the chief administrative law judge of the State Office of Administrative Hearings.
(3) "Enrollee" means an individual who is eligible to receive benefits through a preferred provider benefit plan or a health benefit plan under Chapter 1551.
(4) "Facility-based physician" means a radiologist, an anesthesiologist, a pathologist, an emergency department physician, a neonatologist, or an assistant surgeon:
(A) to whom the facility has granted clinical privileges; and
(B) who provides services to patients of the facility under those clinical privileges.
(5) "Mediation" means a process in which an impartial mediator facilitates and promotes agreement between the insurer offering a preferred provider benefit plan or the administrator and a facility-based physician or the physician's representative to settle a health benefit claim of an enrollee.
(6) "Mediator" means an impartial person who is appointed to conduct a mediation under this chapter.
(7) "Party" means an insurer offering a preferred provider benefit plan, an administrator, or a facility-based physician or the physician's representative who participates in a mediation conducted under this chapter. The enrollee is also considered a party to the mediation.
Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 467 (S.B. 481), Sec. 4, eff. September 1, 2015.
Section: 1467.001 1467.002 1467.003 1467.004 1467.005 1467.051 1467.052 1467.053 1467.054 1467.055 1467.056 1467.057 1467.058 1467.059 1467.060 NextLast modified: September 28, 2016