Tex. Insurance Code § 1301.136
AVAILABILITY OF CODING GUIDELINES
Texas · Texas Insurance Code · Status: effective
Cite this
- Citation
- Tex. Insurance Code § 1301.136, AVAILABILITY OF CODING GUIDELINES, Texas, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/681827
- Permanent ID
ys:prov:681827@1- SHA-256
2e121773c8b0b2caafb05e28953640f5e02cfd2ff9118d405a55e92020bf295a
The hash is SHA-256 of this version's text, with every run of whitespace collapsed to a single space and the ends trimmed. The ID always leads back here, and checking it says whether the text you cited is still the current version.
Full text
(a) A contract between an insurer and a preferred provider must provide that:
(1) the preferred provider may request a description and copy of the coding guidelines, including any underlying bundling, recoding, or other payment process and fee schedules applicable to specific procedures that the preferred provider will receive under the contract;
(2) the insurer or the insurer's agent will provide the coding guidelines and fee schedules not later than the 30th day after the date the insurer receives the request;
(3) the insurer or the insurer's agent will provide notice of changes to the coding guidelines and fee schedules that will result in a change of payment to the preferred provider not later than the 90th day before the date the changes take effect and will not make retroactive revisions to the coding guidelines and fee schedules; and
(4) the contract may be terminated by the preferred provider on or before the 30th day after the date the preferred provider receives information requested under this subsection without penalty or discrimination in participation in other health care products or plans.
(b) A preferred provider who receives information under Subsection (a) may only:
(1) use or disclose the information for the purpose of practice management, billing activities, and other business operations; and
(2) disclose the information to a governmental agency involved in the regulation of health care or insurance.
(c) The insurer shall, on request of the preferred provider, provide the name, edition, and model version of the software that the insurer uses to determine bundling and unbundling of claims.
(d) The provisions of this section may not be waived, voided, or nullified by contract.