Sec. 1452.101. DEFINITIONS. In this subchapter: (1) "Applicant physician" means a physician applying for expedited credentialing under this subchapter. (2) "Enrollee" means an individual who is eligible to receive health care services under a managed care plan. (3) "Health care provider" means: (A) an individual who is licensed, certified, or otherwise authorized to provide health care services in this state; or (B) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services. (4) "Managed care plan" means a health benefit plan under which health care services are provided to enrollees through contracts with health care providers and that requires enrollees to use participating providers or that provides a different level of coverage for enrollees who use participating providers. The term includes a health benefit plan issued by: (A) a health maintenance organization; (B) a preferred provider benefit plan issuer; or (C) any other entity that issues a health benefit plan, including an insurance company. (5) "Medical group" means: (A) a single legal entity owned by two or more physicians; (B) a professional association composed of licensed physicians; (C) any other business entity composed of licensed physicians as permitted under Subchapter B , Chapter 162 , Occupations Code; or (D) two or more physicians on the medical staff of, or teaching at, a medical school or medical and dental unit, as defined or described by Section 61.003 , 61.501 , or 74.601 , Education Code. (6) "Participating provider" means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.
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