About this Dataset

Network Adequacy Waiver Request - Facility-based Physicians & Providers

This dataset includes information related to network adequacy waiver requests filed by major medical health benefit plans. It includes data on facility-based physicians and providers. Related datasets are available for major medical (non-facility-based providers) and vision plans: • Major medical: Network Adequacy Waiver Request - Major Medical. This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on physicians, providers, and facilities, other than facility-based physicians and providers. • Vision: Network Adequacy Waiver Request - Vision. This dataset relates to waiver requests for networks used for vision PPO and EPO plans. Insurers offering health benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information. Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: Network Adequacy Standards Waivers.
Organization: City of Austin
Last updated: 2024-04-25T11:04:33.931920
Tags: acute-inpatient-hospitals-must-have-emergency-services-available-24-7, county, critical-care-services-intensive-care-units-icu, free-standing-emergency-room, health, hearing, insurance, network, network-adequacy, providers, serff, specialty, status, surgical-services-outpatient-or-asc, tdi, waiver

Tables

Table 1

@usgov.city_of_austin_network_adequacy_waiver_request_facilit_009f3e1c.table_1

3.04 MB
590,369 rows
19 columns

CREATE TABLE table_1 (
  "serff_tracking_no" VARCHAR  -- SERFF Tracking No.,
  "naic_no" BIGINT  -- NAIC No.,
  "insurer" VARCHAR,
  "network_id" VARCHAR,
  "network_name" VARCHAR,
  "county_type" VARCHAR,
  "county" VARCHAR,
  "facility_type" VARCHAR,
  "facility_name" VARCHAR,
  "specialty_type" VARCHAR,
  "reason_preferred_providers_not_available" VARCHAR,
  "access_plan_summary" VARCHAR,
  "comments" VARCHAR,
  "are_network_adequacy_standards_met" VARCHAR  -- Are Network Adequacy Standards Met?,
  "hearing_date" VARCHAR,
  "waiver_status" VARCHAR,
  "waiver_decision_date" TIMESTAMP,
  "waiver_start_date" TIMESTAMP,
  "waiver_end_date" TIMESTAMP
);