Code: 

Insurance Code

Title: 

Title 14. Utilization Review and Independent Review

Section: 

4203.001

Name: 

Definition

Eff. Date: 

April 1, 2007

No Rule Reference

§4203.001
Definition

In this chapter, “consultant” means a person who, for compensation and at the request of an insurer, business, individual, or utilization review agent:

(1) reviews, assesses, or evaluates a claim, charge, or service of another chiropractor to determine whether the claim, charge, or service is:

(A) medically necessary, reasonable, or appropriate; or

(B) recommended for payment or nonpayment; or

(2) advises an insurer or utilization review agent regarding a chiropractic charge or service or recommends to that insurer or agent guidelines for a chiropractic charge or service.

Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.