TDI Notification for Health Maintenance Organizations
The purpose of this webpage is to provide important information to Health Maintenance Organizations. Here, you can find a variety of topics such as but not limited to, the Health and Workers’ Compensation Network (HWCN) newsletter, as well as certain events that would require the carrier to notify the Texas Department of Insurance. For more information, please see the links below.
The following information has been provided as a courtesy and is not inclusive of all and/or other instances where entities may be required to notify TDI. The following does not exempt an entity from complying with all requirements in the Texas Insurance Code and Texas Administrative Code.
- Prompt Pay
- TDI News
- Catastrophic Event - An HMO, physician or provider must notify the Texas Department of Insurance (TDI) if, due to a catastrophic event, it is unable to meet the deadlines of the submission of clean claims required under 28 TAC §21.2819. The entity must send the notification to TDI within five days of the catastrophic event. Within ten days after the entity returns to normal business operations, the entity must send a certification of the catastrophic event to TDI.
- Contract Issues - All participation contracts between a physician or provider and an HMO carrier must contain certain provisions to ensure that health care services are arranged appropriately. An HMO is required to notify TDI prior to and subsequent to the issuance of a Certificate of Authority (COA) of any new form of contract, subcontract or substantive changes to a previously filed contract. An HMO notifies TDI by filing these participation contracts (forms) with the Managed Care Quality Assurance (MCQA) Office. These forms are normally filed for information only subsequent to a COA and are subject to review upon audit.
- Contact us with any complaint or contact changes
For more information contact:
Last updated: 06/27/2013