§ 56-60-107. Requirements for Granting a Third Party Access to the Contracting Entity’s Provider Network — Refusal to Accept Contractual Discount
No contracting entity shall grant a third party access to the contracting entity’s provider network contract by lease, rent or by any other means unless the third party accessing the provider network contract is: A payer of claims or a third party administrator or other entity that administers or processes claims on behalf of the […]
§ 56-60-108. Enforcement — Rules
The department shall enforce this chapter. The department is authorized to promulgate rules to effectuate this chapter in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. The initial rules promulgated by the department may be designated as emergency rules if the department finds that it cannot implement the rules by […]
§ 56-60-109. Unfair Insurance Practice — Complaints for Violations
It is an unfair insurance practice for the purposes of the Tennessee Unfair Trade Practices and Unfair Claims Settlement Act of 2009, compiled in chapter 8, part 1 of this title, to knowingly access a provider’s services or exercise a provider’s contractual discounts pursuant to a provider network contract if the access or exercise is […]
§ 56-60-105. Granting a Third Party Access to a Provider’s Health Care Services and Contractual Discounts Pursuant to a Provider Network Contract
A contracting entity shall only grant access to a provider’s health care services and contractual discounts pursuant to the contracting entity’s provider network contract if: The provider network contract clearly and plainly authorizes the contracting entity to enter into an agreement with a third party allowing the third party to exercise the contracting entity’s rights […]
§ 56-60-106. Subsequent Grants of Access to Another Third Party
Any third party, having itself been granted access to a provider’s health care services and contractual discounts pursuant to a provider network contract, that subsequently grants access to another third party, is obligated to comply with the rights and responsibilities imposed on contracting entities under §§ 56-60-104 and 56-60-105. Any third party that enters into […]
§ 56-60-101. Short Title
This chapter shall be known and may be cited as the “Preferred Provider Organization Transparency Act.”
§ 56-60-102. Chapter Definitions
As used in this chapter: “Affiliate” means an individual or entity that directly or indirectly through one (1) or more intermediaries, controls or is controlled by or is under common control with a contracting entity; “Contracting entity” means any individual or entity that is engaged in the act of contracting with providers and that has […]
§ 56-60-103. Exceptions
This chapter does not apply: In circumstances where access to the provider network contract is granted to an affiliate or a subsidiary of a contracting entity, or other entity if operating under the same brand licensee program as the contracting entity; To a contract between a contracting entity and a discount medical plan organization; or […]
§ 56-60-104. Registration as a Contracting Entity
Any individual or entity that commences business as a contracting entity shall register with the department within thirty (30) days of commencing business in this state unless the individual or entity is licensed by the department as an insurer or third party administrator. Any contracting entity not licensed by the department as an insurer or […]