{"data":{"id":"us-tx/tex.-insurance-code-1213.003","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 1213.003","heading":"ELECTRONIC SUBMISSION OF CLAIMS: WAIVER.","body":"(a) A contract between the issuer of a health benefit plan and a health care professional or health care facility must provide for a waiver of any requirement for electronic submission established under this chapter.\n(b) The commissioner shall establish circumstances under which a waiver is required, including:\n(1) circumstances in which no method is available for the submission of claims in electronic form;\n(2) the operation of small physician practices;\n(3) the operation of other small health care provider practices;\n(4) undue hardship, including fiscal or operational hardship; or\n(5) any other special circumstance that would justify a waiver.\n(c) Any health care professional or health care facility that is denied a waiver by the issuer of a health benefit plan may appeal the denial to the commissioner. The commissioner shall determine whether a waiver must be granted.\n(d) The issuer of a health benefit plan may not refuse to contract or renew a contract with a health care professional or health care facility based in whole or in part on the professional or facility requesting or receiving a waiver or appealing a waiver determination.\nAdded by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.","path":["INSURANCE CODE","TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES","SUBTITLE A. HEALTH COVERAGE IN GENERAL","CHAPTER 1213. ELECTRONIC HEALTH CARE TRANSACTIONS"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1213.htm#1213.003","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"dbf5073a980e9d9e48bc95c2e1ef4e0d1c2282c5244db7e35b5de6751aee837b","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-1213.002","next":"us-tx/tex.-insurance-code-1213.004"},"notice":"GroundRules: Original legal text. Not legal advice."}