2005 Texas Insurance Code CHAPTER 1457. PROVISIONAL CREDENTIALING STATUS

INSURANCE CODE

CHAPTER 1457. PROVISIONAL CREDENTIALING STATUS


	§ 1457.001. DEFINITIONS.  In this chapter:                                  
		(1)  "Enrollee" means an individual who is eligible to 
receive health care services through a health benefit plan.
		(2)  "Physician" means an individual licensed to 
practice medicine in this state under the authority of Subtitle B, 
Title 3, Occupations Code.
		(3)  "Provider network" means a health benefit plan 
under which health care services are provided to enrollees through 
contracts with physicians and that requires those enrollees to use 
physicians participating in the plan and procedures covered by the 
plan.  The term includes a network operated by:
			(A)  a health maintenance organization;                                      
			(B)  a preferred provider organization;  or                                  
			(C)  another entity that issues a health benefit 
plan, including an insurance company.

Added by Acts 2005, 79th Leg., ch. 789, § 2, eff. June 17, 2005.           


	§ 1457.002. PROVISIONAL CREDENTIALING STATUS.  (a) A 
health benefit plan shall have a process for provisional 
credentialing status in compliance with the requirements of the 
National Committee for Quality Assurance.
	(b)  A health benefit plan may grant provisional 
credentialing status to a physician who:
		(1)  submits a completed standard credentialing 
application to the health benefit plan;
		(2)  meets the health plan's requirements for 
provisional credentialing;  and
		(3)  joins as a partner, shareholder, or employee of 
another physician who is contracted with a health benefit plan to 
provide medical or health care services to enrollees.
	(c)  A health benefit plan must complete the credentialing 
process within 60 calendar days of the date a physician is granted 
provisional status.  In the event the physician does not meet the 
health plan's credentialing standards, the physician must be 
provided the same appeal process as any other physician applying 
for participation with the health benefit plan.

Added by Acts 2005, 79th Leg., ch. 789, § 2, eff. June 17, 2005.