Texas Insurance Code 1452.156 – Effect of Failure to Meet Credentialing Requirements
Current as of: 2024 | Check for updates
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If, on completion of the credentialing process, the managed care plan issuer determines that the applicant podiatrist does not meet the issuer’s credentialing requirements:
(1) the managed care plan issuer may recover from the applicant podiatrist or the podiatrist’s professional practice an amount equal to the difference between payments for in-network benefits and out-of-network benefits; and
(2) the applicant podiatrist or the podiatrist’s professional practice may retain any copayments collected or in the process of being collected as of the date of the issuer’s determination.