Insurance Code § 1467.006

Sec. 1467.006. BENCHMARKING DATABASE. (a) In this section, "geozip area" means an area that includes all zip codes with identical first three digits. For purposes of this section, a health care or medical service or supply provided at a location that does not have a zip code is considered to be provided in the geozip area closest to the location at which the service or supply is provided. (b) The commissioner shall select an organization to maintain a benchmarking database in accordance with this section. The organization may not: (1) be affiliated with a health benefit plan issuer or administrator or a physician, health care practitioner, or other health care provider; or (2) have any other conflict of interest. (c) The benchmarking database must contain information necessary to calculate, with respect to a health care or medical service or supply, for each geozip area in this state: (1) the 80th percentile of billed charges of all physicians or health care providers who are not facilities; and (2) the 50th percentile of rates paid to participating providers who are not facilities. (d) The commissioner may adopt rules governing the submission of information for the benchmarking database described by Subsection (c). Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.03, eff. September 1, 2019. SUBCHAPTER B. MANDATORY MEDIATION FOR OUT-OF-NETWORK FACILITIES