This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:36 GMT
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.(1) Claim--An application for payment of health care services under Title XIX of the Social Security Act that is submitted by a person who is under a contract or provider agreement with DHS.(2) Contract or provider agreement--Any written document (or series of documents) that obligates DHS or its health insuring agent to pay a person money under Title XIX of the Social Security Act in exchange for his goods or services. Included are claims for payment that a licensed practitioner (as defined by federal law) submits for services provided to Medicaid recipients.(3) Commissioner--The commissioner of the Texas Department of Human Services.(4) Days--Calendar days, unless otherwise specified.(5) Department--The Texas Department of Human Services.(6) Health insuring agent--An organization legally operating in the state that:(A) pays providers of certain Title XIX medical services and supplies in exchange for premiums paid by DHS; and(B) assumes an underwriting risk.(7) Person--An individual, partnership, corporation, association, other organization, or legal entity that has a contract or provider agreement with DHS.(8) Practitioner--A physician or other person licensed by the state to practice a profession.(9) Provider--A person who has a contract or provider agreement with DHS.(10) Title XIX--Title XIX of the Social Security Act.