Texas Warns Carriers On Provider Fee Disclosure

The Texas department adopted rules in September 2002 that implement a law that requires health maintenance organizations and insurers that use preferred provider networks to offer providers access to detailed fee schedules.

The rules also requires carriers to notify providers 60 days before making fee changes. In September 2003, the Texas department amended the rules to reflect a new law that requires carriers to give providers 90 days’ notice about fee changes.

“It has recently come to TDI’s attention that some carriers are notifying their contracted physicians and providers of fee schedule changes by providing a representative sample of the new fees,” Stokes writes in the bulletin. “While specific codes and fees listed in a representative sample would comply with the notice requirement if applicable to the notice recipient, the sample would not satisfy the requirements of the rules regarding those fee changes not illustrated in the sample.”

The Texas department has posted the bulletin on the Web at http://www.tdi.state.tx.us/commish/bulletins/b-0017-4.html