1. (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.

2. (b) The commissioner shall establish circumstances under which a waiver is required, including:

   1. (1) circumstances in which no method is available for the submission of claims in electronic form;
   2. (2) the operation of small physician practices;
   3. (3) the operation of other small health care provider practices;
   4. (4) undue hardship, including fiscal or operational hardship; or
   5. (5) any other special circumstance that would justify a waiver.
3. (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.
4. (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.

Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.