Form No. LHL616 (Health Care Claims Reimbursement Rate Report) is adopted by reference. The form:   (1) contains instructions for completion of the report and requires submission of information and data concerning group health benefit plan issuer identification and enrollment information;   (2) requires the submission of both contracted and out-of-network claim information for general professional services; pathology services; anesthesiology services; radiology services; neonatology services; outpatient professional and institutional provider services; and inpatient institutional provider services; and   (3) is available at http://www.tdi.state.tx.us/forms/form10accident.html.

Source Note: The provisions of this §21.4507 adopted to be effective January 9, 2011, 35 TexReg 11868