{"key":"tx_sb1264","name":"Texas SB 1264 out-of-network claim arbitration (non-facility provider track)","regulation_cite":"Insurance Code ch. 1467; 28 TAC ch. 21 subch. OO/PP","selection_kind":"choose_one_of_two_offers","assignment_kind":"regulator_random_assignment","deadlines":{"unit":"calendar_day","determination_days":51,"attest_days":null,"eligibility_days":null},"required_credentials":["JD","MANAGED_CARE_EXPERIENCE"],"permitted_factors":[{"key":"gross_disparity_billed_vs_paid","label":"Gross disparity between the billed fee and fees paid to other out-of-network enrollees and providers"},{"key":"provider_training_experience_quality","label":"Level of training, education, and experience of the provider"},{"key":"provider_usual_billed_charge","label":"The provider's usual billed charge for comparable services to other enrollees"},{"key":"circumstances_and_complexity","label":"Circumstances and complexity of the case, including time and place of service"},{"key":"enrollee_characteristics","label":"Individual characteristics of the enrollee"},{"key":"billed_charges_80th_percentile","label":"80th percentile of billed charges in the same specialty and geozip"},{"key":"allowed_rates_50th_percentile","label":"50th percentile of rates paid to participating providers in the same specialty and geozip"},{"key":"network_contracting_history","label":"History of network contracting between the parties"},{"key":"historical_percentile_data","label":"Historical data for the 80th and 50th percentiles above"},{"key":"informal_teleconference_offer","label":"An offer made during the informal settlement teleconference"}],"fee_rule":{"kind":"per_review_contract","single_range":null,"batched_range":null,"fixed_amount_usd":null,"dismissed_amount_usd":null,"paid_by":null}}