Tex. Ins. Code § 1301.136 · Subchapter C-1. OTHER PROVISIONS RELATING TO PAYMENT OF CLAIMS
AVAILABILITY OF CODING GUIDELINES.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) A contract between an insurer and a preferred provider must provide that:
(1) the preferred provider may request a description and copy of the coding guidelines, including any underlying bundling, recoding, or other payment process and fee schedules applicable to specific procedures that the preferred provider will receive under the contract;
(2) the insurer or the insurer's agent will provide the coding guidelines and fee schedules not later than the 30th day after the date the insurer receives the request;
(3) the insurer or the insurer's agent will provide notice of changes to the coding guidelines and fee schedules that will result in a change of payment to the preferred provider not later than the 90th day before the date the changes take effect and will not make retroactive revisions to the coding guidelines and fee schedules; and
(4) the contract may be terminated by the preferred provider on or before the 30th day after the date the preferred provider receives information requested under this subsection without penalty or discrimination in participation in other health care products or plans.
(b) A preferred provider who receives information under Subsection (a) may only:
(1) use or disclose the information for the purpose of practice management, billing activities, and other business operations; and
(2) disclose the information to a governmental agency involved in the regulation of health care or insurance.
(c) The insurer shall, on request of the preferred provider, provide the name, edition, and model version of the software that the insurer uses to determine bundling and unbundling of claims.
(d) The provisions of this section may not be waived, voided, or nullified by contract.
Notes and commentary — not statutory text
History
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.037(b), eff. September 1, 2005.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1301.htm
- Text hash
- sha256 8fbbc3534695b9fc85633f50742a8535a96ee068a36e7e92e77b7db7e32ef3b3
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.