4201.202
(a) Unless approved for an individual patient by the provider of record or modified by contract, a utilization review agent shall be prohibited from observing, participating in, or otherwise being present during a patient’s examination, treatment, procedure, or therapy. (b) This subchapter, Subchapters D and F, and Section 4201.102(b) may not be construed to otherwise […]
4201.153
(a) A utilization review agent shall use written medically acceptable screening criteria and review procedures that are established and periodically evaluated and updated with appropriate involvement from physicians, including practicing physicians, dentists, and other health care providers. (b) A utilization review determination shall be made in accordance with currently accepted medical or health care practices, […]
4201.105
The commissioner shall establish, administer, and enforce the fees for initial certification and certification renewal in amounts that do not exceed the amounts necessary to cover the cost of administering this chapter. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4201.106
A certificate of registration is not transferable. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4201.107
A utilization review agent shall report any material change to the information disclosed in a form filed under this subchapter not later than the 30th day after the date the change takes effect. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4201.108
(a) The commissioner shall maintain and update monthly a list of each utilization review agent to whom a certificate of registration has been issued and the renewal date of the certificate. (b) The commissioner shall provide the list at cost to each individual or organization requesting the list. Added by Acts 2005, 79th Leg., ch. […]
4201.101
A utilization review agent may not conduct utilization review unless the commissioner issues a certificate of registration to the agent under this subchapter. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4201.102
(a) The commissioner may issue a certificate of registration only to an applicant who has met all the requirements of this chapter and all applicable rules adopted by the commissioner. (b) As a condition of holding a certificate of registration or renewal of a certificate, a utilization review agent must maintain compliance with Subchapters D, […]
4201.103
Certification may be renewed biennially by filing, not later than March 1, a renewal form with the commissioner accompanied by a fee in an amount set by the commissioner. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4201.104
(a) The commissioner shall promulgate forms to be filed under this subchapter for initial certification and for a renewal certificate of registration. The form for initial certification must require: (1) the utilization review agent’s name, address, telephone number, and normal business hours; (2) the name and address of an agent for service of process in […]