Sec. 35A.01. Definitions

"Claim" means a written or electronically submitted request or demand that:

is submitted by a provider or the provider’s agent and identifies a service or product provided or purported to have been provided to a health care recipient as reimbursable under a health care program, without regard to whether the money that is requested or demanded is paid; or

states the income earned or expense incurred by a provider in providing a service or product and is used to determine a rate of payment under a health care program.

"Fiscal agent" means:

a person who, through a contractual relationship with a state agency or the federal government, receives, processes, and pays a claim under a health care program; or

the designated agent of a person described by Paragraph (A).

"Health care practitioner" means a dentist, podiatrist, psychologist, physical therapist, chiropractor, registered nurse, or other provider licensed to provide health care services in this state.

"Health care program" means a program funded by this state, the federal government, or both and designed to provide health care services to health care recipients, including a program that is administered in whole or in part through a managed care delivery model.

"Health care recipient" means an individual to whom a service or product is provided or purported to have been provided and with respect to whom a person claims or receives a payment for that service or product from a health care program or fiscal agent, without regard to whether the individual was eligible for benefits under the health care program.

"Managed care organization" means a person who is authorized or otherwise permitted by law to arrange for or provide a managed care plan.

"Physician" means a physician licensed to practice medicine in this state.

"Provider" means a person who participates in or has applied to participate in a health care program as a supplier of a service or product and includes:

a management company that manages, operates, or controls another provider;

a person, including a medical vendor, who provides a service or product to another provider or the other provider’s agent;

an employee of the person who participates in or has applied to participate in the program;

a managed care organization; and

a manufacturer or distributor of a product for which a health care program provides reimbursement.

"Service" includes care or treatment of a health care recipient.

"High managerial agent" means a director, officer, or employee who is authorized to act on behalf of a provider and has duties of such responsibility that the conduct of the director, officer, or employee reasonably may be assumed to represent the policy or intent of the provider.