Tennessee Code 56-51-130 – Contract providers
Terms Used In Tennessee Code 56-51-130
- Limited health service: means dental care services, vision care services, mental health services, substance abuse services, and pharmaceutical services. See Tennessee Code 56-51-102
- Prepaid limited health service organization: means any person, corporation, partnership, or any other entity that, in return for a prepayment from a health maintenance organization or a state or federal agency, undertakes to provide or arrange for, or provide access to, the provision of a limited health service to enrollees through an exclusive panel of providers. See Tennessee Code 56-51-102
- Provider: means , but is not limited to, any physician, dentist, health facility, or other person or institution that is duly licensed in this state to deliver limited health services. See Tennessee Code 56-51-102
A prepaid limited health service organization that subcontracts with another entity to obtain a network of providers to furnish services to members or enrollees shall guarantee and assure the payment of all contracted amounts agreed to be paid to such providers by that entity or that entity’s agent. This section does not preclude the prepaid limited health service organization from seeking reimbursement from the subcontractor for any amounts paid pursuant to this section. Nor does this section prevent the prepaid limited health service organization from asserting any legal defenses to the payment of a provider‘s claim that were available to the subcontractor. This section shall be effective for all provider claims for services delivered after January 1, 2001.