28 TAC § 21.5001. Purpose, DIVISION 1. GENERAL PROVISIONS

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.