Texas § IN.1453.002 - PROVISION OF INFORMATION REGARDING REIMBURSEMENT GUIDELINES

§ IN.1453.002. PROVISION OF INFORMATION REGARDING REIMBURSEMENT GUIDELINES

PROVISION OF INFORMATION REGARDING REIMBURSEMENT GUIDELINES. (a) On the written request of an out-of-network health care provider, a managed care entity shall furnish to the provider a written description of the factors considered by the entity in determining the amount of reimbursement the provider may receive for goods or services provided to an individual enrolled in or insured under the entity's managed care plan. (b) This section does not require a managed care entity to disclose proprietary information that is prohibited from disclosure by a contract between the entity and a vendor that supplies payment or statistical data to the entity. (c) A contract between a managed care entity and a vendor that supplies payment or statistical data to the entity may not prohibit the entity from disclosing under this section: (1) the name of the vendor; or (2) the methodology and origin of information used to determine the amount of reimbursement. (d) A managed care entity that denies a request for information described by Subsection (b) shall send a copy of the request and the information requested to the department for review. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.