Sec. 1460.003. PHYSICIAN RANKING REQUIREMENTS. (a) A health benefit plan issuer, including a subsidiary or affiliate, may not rank physicians or classify physicians into tiers based on performance unless: (1) the standards used by the health benefit plan issuer to rank or classify are developed or prescribed by an organization designated by the commissioner through rules adopted under Section 1460.005 ; (2) the ranking or classification and any methodology used to rank or classify: (A) is disclosed to each affected physician at least 45 days before the date the ranking or classification is released, published, or distributed by the health benefit plan issuer; and (B) identifies which products or networks offered by the health benefit plan issuer the ranking or classification will be used for; and (3) each affected physician is given an easy-to-use process to identify: (A) before the release, publication, or distribution of the ranking or classification, any discrepancy between the standards and the ranking or classification proposed by the health benefit plan issuer; and (B) after the release, publication, or distribution of the ranking or classification, any objectively and verifiably false information contained in the ranking or classification. (a-1) If a physician submits information under Subsection (a)(3) sufficient to establish a verifiable discrepancy or objectively and verifiably false information contained in the ranking or classification or a violation of this chapter, the health benefit plan issuer must remedy the discrepancy, false information, or violation by the later of: (1) the release, publication, or distribution of the ranking or classification; or (2) the 30th day after the date the health benefit plan issuer receives the information. (b) This section does not apply to the publication of a list of network physicians and providers if ratings or comparisons are not made and the list is not a product of nor reflects the tiering or classification of physicians or providers.
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