10.63
(a) The notice of network requirements and employee information form and acknowledgment form required by Insurance Code §1305.451, concerning Employee Information; Responsibilities of Employee, and 10.60 of this title (relating to Notice of Network Requirements; Employee Information) must be written in plain language and comply with the following requirements: (1) the text must achieve a […]
10.41
(a) A network’s contract with a carrier must include the following: (1) a description of the functions to be performed by the network or its delegated entity, consistent with the requirements of Insurance Code §1305.154(b), concerning Network-Carrier Contracts, and the reporting requirements for each function; (2) a statement that the network will perform all delegated […]
10.42
(a) A network is not required to accept an application for participation in the network from a health care provider that otherwise meets the requirements specified in this chapter if the network determines that the network has contracted with a sufficient number of qualified health care providers, including health care providers of the same license […]
10.60
(a) An insurance carrier that establishes or contracts with a network must deliver to the employer, and the employer or carrier, as applicable under subsection (g) of this section, must deliver to the employer’s employees in the manner and at the times prescribed by Insurance Code §1305.005, concerning Participation in Network; Notice of Network Requirements: […]
10.2
(a) The following words and terms when used in this chapter have the following meanings unless the context clearly indicates otherwise. (1) Administrator–Has the meaning assigned by Insurance Code §4151.001, concerning Definitions. (2) Adverse determination–A determination by a URA made on behalf of a payor that the health care services provided or proposed to be […]
10.3
Current email addresses, mailing addresses, and telephone numbers for the Division of Workers’ Compensation and MCQA are available on the department’s website. This contact information should be used when an email address, mailing address, or telephone number is referenced in a section in this chapter. The provisions of this 10.3 adopted to be effective August […]
10.27
(a) A network must file a modification request with and receive approval from the department before the network makes a material modification to its network configuration. The modification request must be filed not later than 30 days prior to implementation of the material modification. (b) A modification request for a modification to network configuration must […]
10.40
(a) A network may not enter into a contract with another entity for management services, or modify a previously approved management contract, unless the proposed contract or modification is first filed with the department and approved by the Commissioner in accordance with Insurance Code §1305.102, concerning Management Contracts. (b) For purposes of this chapter, management […]
10.24
(a) On at least a calendar year basis, each network must prepare financial statements in accordance with generally accepted accounting principles, which must include: (1) a balance sheet; (2) an income statement; (3) a cash flow statement; (4) a statement of equity; and (5) a supplemental description of the network’s basic organizational structure, general business […]
10.25
(a) A network must file with the department as soon as practicable but not later than 30 days prior to implementation, a written request for approval and must receive department approval before implementation of changes to the following: (1) management contracts and information regarding fidelity bonds as described in Insurance Code §1305.102, concerning Management Contracts, […]