(a) 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 not pursuant to a contractual relationship with the provider or with a contracting entity or third party who has a contractual relationship with the provider as specified in this chapter.

Terms Used In Tennessee Code 56-60-109

  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Contracting entity: means any individual or entity that is engaged in the act of contracting with providers and that has entered into a provider network contract with a provider for the delivery of health care services. See Tennessee Code 56-60-102
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Department: means the department of commerce and insurance. See Tennessee Code 56-60-102
  • Entity: means a corporation, business trust, trust, partnership, limited liability company, association, joint venture, public corporation, government or governmental subdivision, agency or instrumentality, or any other legal or commercial entity. See Tennessee Code 56-60-102
  • Provider: means a physician, a physician organization or a physician hospital organization. See Tennessee Code 56-60-102
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • Third party: means an organization that enters into a contract with a contracting entity or with another third party to gain access to a provider network contract. See Tennessee Code 56-60-102
(b)

(1) To effectuate the purposes of this section, the department shall develop a complaint form for providers or others to submit alleging violations of this chapter.
(2) Information provided in good faith to the department shall not make the provider or other individual or entity providing the information liable for civil damages as a result of providing the information.
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