Texas Insurance Code

§ 38.402 — DEFINITIONS

IN § 38.402Title 2. TEXAS DEPARTMENT OF INSURANCE · Part A. ADMINISTRATION OF THE TEXAS DEPARTMENT OF INSURANCE · Ch. 38. DATA COLLECTION AND REPORTS · Art. I. TEXAS ALL PAYOR CLAIMS DATABASE

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In this subchapter:

(1)"Allowed amount" means the amount of a billed charge that a health benefit plan issuer determines to be covered for services provided by a non-network provider. The allowed amount includes both the insurer's payment and any applicable deductible, copayment, or coinsurance amounts for which the insured is responsible.

(2)"Center" means the Center for Healthcare Data at The University of Texas Health Science Center at Houston.

(3)"Contracted rate" means the fee or reimbursement amount for a network provider's services, treatments, or supplies as established by agreement between the provider and health benefit plan issuer.

(4)"Data" means the specific claims and encounters, enrollment, and benefit information submitted to the center under this subchapter.

(5)"Database" means the Texas All Payor Claims Database established under this subchapter.

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Legislative history

Acts 2023, 88th Leg., R.S., Ch. 603 (H.B. 3414), Sec. 1, eff. June 11, 2023. Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.117, eff. April 1, 2025.