If the rate exceeds our benchmark rates then the carrier s bid is rejected. Provider networks for the bid areas. The ERS staff uses a software package widely recognized as an access tool to determine provider availability by area for the entire State of Texas. Networks are reviewed to ensure that carriers satisfy guidelines that will assure our members adequate access to primary care and specialty care providers as well as provider facilities. Provider networks are subject to change since HMOs contract directly with each physician or provider group.
Providers join or terminate from networks based on their own business decisions.
ERS staff monitors these changes to ensure the availability and accessibility of providers. Texas Department of Insurance actions or pending actions are considered. If no apparent problems exist the carrier review is continued. Communication of benefits. Quality of care issues.