SECTION 21.5001. Purpose  


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  • The purpose of this subchapter is to:

    (1) prescribe the process for requesting, initiating, and conducting mandatory mediation and mandatory binding arbitration of claims as authorized in Insurance Code Chapter 1467, concerning Out-of-Network Claim Dispute Resolution;

    (2) facilitate the process for the investigation and review of a complaint filed with the department that relates to the settlement of an out-of-network claim under Insurance Code Chapter 1467;

    (3) prescribe the contents of the explanation of benefits as required by Insurance Code §1271.008, concerning Balance Billing Prohibition Notice; §1275.003, concerning Balance Billing Prohibition Notice; §1301.010, concerning Balance Billing Prohibition Notice; §1551.015, concerning Balance Billing Prohibition Notice; §1575.009, concerning Balance Billing Prohibition Notice; and §1579.009, concerning Balance Billing Prohibition Notice; and

    (4) facilitate the collection of data as authorized in Insurance Code §1467.006, concerning Benchmarking Database.

Source Note: The provisions of this §21.5001 adopted to be effective October 19, 2010, 35 TexReg 9300; amended to be effective November 3, 2016, 41 TexReg 8612; amended to be effective April 26, 2018, 43 TexReg 2423; amended to be effective December 23, 2019, 44 TexReg 7988; amended to be effective June 27, 2023, 48 TexReg 3409