Texas Insurance Code 1272.053 – Monitoring Plan
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Terms Used In Texas Insurance Code 1272.053
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
A delegation agreement required by Section 1272.052 must establish a monitoring plan that:
(1) allows the health maintenance organization to monitor compliance with the minimum solvency requirements established under Subchapter D, if applicable; and
(2) includes:
(A) a description of financial practices that will ensure that the delegated entity tracks and reports liabilities that have been incurred but not reported;
(B) a summary of the total amount paid by the entity to physicians and providers on a monthly basis; and
(C) a summary of complaints from physicians, providers, and enrollees regarding delays in payment or nonpayment of claims, including the status of each complaint, on a monthly basis.