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Texas Insurance Code - INS § 1460.003. Physician Ranking Requirements

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) A health benefit plan issuer, including a subsidiary or affiliate, may not rank physicians or classify physicians into tiers based on performance unless:

(1) the standards used by the health benefit plan issuer to rank or classify are developed or prescribed by an organization designated by the commissioner through rules adopted under Section 1460.005;

(2) the ranking or classification and any methodology used to rank or classify:

(A) is disclosed to each affected physician at least 45 days before the date the ranking or classification is released, published, or distributed by the health benefit plan issuer;  and

(B) identifies which products or networks offered by the health benefit plan issuer the ranking or classification will be used for;  and

(3) each affected physician is given an easy-to-use process to identify:

(A) before the release, publication, or distribution of the ranking or classification, any discrepancy between the standards and the ranking or classification proposed by the health benefit plan issuer;  and

(B) after the release, publication, or distribution of the ranking or classification, any objectively and verifiably false information contained in the ranking or classification.

(a-1) If a physician submits information under Subsection (a)(3) sufficient to establish a verifiable discrepancy or objectively and verifiably false information contained in the ranking or classification or a violation of this chapter, the health benefit plan issuer must remedy the discrepancy, false information, or violation by the later of:

(1) the release, publication, or distribution of the ranking or classification;  or

(2) the 30th day after the date the health benefit plan issuer receives the information.

(b) This section does not apply to the publication of a list of network physicians and providers if ratings or comparisons are not made and the list is not a product of nor reflects the tiering or classification of physicians or providers.

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 1460.003. Physician Ranking Requirements - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-1460-003/

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