Texas § 1213.003 ELECTRONIC SUBMISSION OF CLAIMS: WAIVER.

Texas Statutes

§ 1213.003 — ELECTRONIC SUBMISSION OF CLAIMS: WAIVER.

Texas § 1213.003

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Bluebook

Tex. Insurance Code Code Ann. § 1213.003 (2026).

Text

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 is

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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.