Texas Insurance Code Title 8, Chapter 1452 - Physician And Provider Credentials

SUBCHAPTER A CREDENTIALING OF PHYSICIANS AND PROVIDERS BY HEALTH MAINTENANCE ORGANIZATION

• Texas Section 1452.001 - Applicability Of Certain Definitions
  In this subchapter, a term defined by Section 843.002 has the meaning assigned by that section. Added by Acts 2003, 78th Leg., ch. 1274, Sec....
• Texas Section 1452.002 - Verification Of Physician's License Or Certificate
  The commissioner shall require a health maintenance organization to verify that a physician's license to practice medicine and any other certificate the physician is required...
• Texas Section 1452.003 - Site Visit For Initial Credentialing
  (a) The commissioner shall require a health maintenance organization that conducts a site visit for the purpose of initial credentialing of a physician or provider...
• Texas Section 1452.004 - Limitation On Commissioner's Authority
  The commissioner may not require a health maintenance organization to: (1) formally recredential a physician or provider more frequently than once in any three-year period;...
• Texas Section 1452.005 - Site Visit For Cause Not Precluded
  This subchapter does not preclude a health maintenance organization from conducting a site visit of a physician or provider at any time for cause, including...

SUBCHAPTER B STANDARDIZED FORMS

• Texas Section 1452.006 - Rules Related To Selection Of Physicians And Providers By Health Maintenance Organization
  A rule adopted by the commissioner under Section 843.102 that relates to implementation and maintenance by a health maintenance organization of a process for selecting...
• Texas Section 1452.051 - Definitions
  In this subchapter: (1) "Advanced practice nurse" has the meaning assigned by Section 301.152, Occupations Code. (2) "Physician" means an individual licensed to practice medicine...

SUBCHAPTER C EXPEDITED CREDENTIALING PROCESS

• Texas Section 1452.052 - Standardized Form For Verification Of Credentials
  (a) The commissioner by rule shall: (1) prescribe a standardized form for the verification of the credentials of a physician, advanced practice nurse, or physician...
• Texas Section 1452.101 - Definitions
  In this subchapter: (1) "Applicant physician" means a physician applying for expedited credentialing under this subchapter. (2) "Enrollee" means an individual who is eligible to...
• Texas Section 1452.102 - Applicability
  This subchapter applies only to a physician who joins an established medical group that has a current contract in force with a managed care plan....
• Texas Section 1452.103 - Eligibility Requirements
  To qualify for expedited credentialing under this subchapter and payment under Section 1452.104, an applicant physician must: (1) be licensed in this state by, and...
• Texas Section 1452.104 - Payment Of Applicant Physician During Credentialing Process
  On submission by the applicant physician of the information required by the managed care plan issuer under Section 1452.103(2), and for payment purposes only, the...
• Texas Section 1452.105 - Directory Entries
  Pending the approval of an application submitted under Section 1452.104, the managed care plan may exclude the applicant physician from the managed care plan's directory...
• Texas Section 1452.106 - Effect Of Failure To Meet Credentialing Requirements
  If, on completion of the credentialing process, the managed care plan issuer determines that the applicant physician does not meet the issuer's credentialing requirements: (1)...
• Texas Section 1452.107 - Enrollee Held Harmless
  An enrollee in the managed care plan is not responsible and shall be held harmless for the difference between in-network copayments paid by the enrollee...

SUBCHAPTER D EXPEDITED CREDENTIALING PROCESS

• Texas Section 1452.108 - Limitation On Managed Care Issuer Liability
  A managed care plan issuer that complies with this subchapter is not subject to liability for damages arising out of or in connection with, directly...
• Texas Section 1452.151 - Definitions
  In this subchapter: (1) "Applicant podiatrist" means a podiatrist applying for expedited credentialing under this subchapter. (2) "Enrollee" means an individual who is eligible to...
• Texas Section 1452.152 - Applicability
  This subchapter applies only to a podiatrist who joins an established professional practice that has a current contract in force with a managed care plan....
• Texas Section 1452.153 - Eligibility Requirements
  To qualify for expedited credentialing under this subchapter and payment under Section 1452.154, an applicant podiatrist must: (1) be licensed in this state by, and...
• Texas Section 1452.154 - Payment Of Applicant Podiatrist During Credentialing Process
  On submission by the applicant podiatrist of the information required by the managed care plan issuer under Section 1452.153(2), and for payment purposes only, the...
• Texas Section 1452.155 - Directory Entries
  Pending the approval of an application submitted under Section 1452.154, the managed care plan may exclude the applicant podiatrist from the managed care plan's directory...
• Texas Section 1452.156 - Effect Of Failure To Meet Credentialing Requirements
  If, on completion of the credentialing process, the managed care plan issuer determines that the applicant podiatrist does not meet the issuer's credentialing requirements: (1)...
• Texas Section 1452.157 - Enrollee Held Harmless
  An enrollee in the managed care plan is not responsible and shall be held harmless for the difference between in-network copayments paid by the enrollee...

SUBCHAPTER E EXPEDITED CREDENTIALING PROCESS

• Texas Section 1452.158 - Limitation On Managed Care Issuer Liability
  A managed care plan issuer that complies with this subchapter is not subject to liability for damages arising out of or in connection with, directly...
• Texas Section 1452.201 - Definitions
  In this subchapter: (1) "Applicant therapeutic optometrist" means a therapeutic optometrist applying for expedited credentialing under this subchapter. (2) "Enrollee" means an individual who is...
• Texas Section 1452.202 - Applicability
  This subchapter applies only to a therapeutic optometrist who joins an established professional practice that has a current contract in force with a managed care...
• Texas Section 1452.203 - Eligibility Requirements
  To qualify for expedited credentialing under this subchapter and payment under Section 1452.204, an applicant therapeutic optometrist must: (1) be licensed in this state by,...
• Texas Section 1452.204 - Payment Of Applicant Therapeutic Optometrist During Credentialing Process
  On submission by the applicant therapeutic optometrist of the information required by the managed care plan issuer under Section 1452.203(2), and for payment purposes only,...
• Texas Section 1452.205 - Directory Entries
  Pending the approval of an application submitted under Section 1452.204, the managed care plan may exclude the applicant therapeutic optometrist from the managed care plan's...
• Texas Section 1452.206 - Effect Of Failure To Meet Credentialing Requirements
  If, on completion of the credentialing process, the managed care plan issuer determines that the applicant therapeutic optometrist does not meet the issuer's credentialing requirements:...
• Texas Section 1452.207 - Enrollee Held Harmless
  An enrollee in the managed care plan is not responsible and shall be held harmless for the difference between in-network copayments paid by the enrollee...
• Texas Section 1452.208 - Limitation On Managed Care Issuer Liability
  A managed care plan issuer that complies with this subchapter is not subject to liability for damages arising out of or in connection with, directly...

Last modified: September 28, 2016