1305.008
A person that performs the functions of an administrator under Chapter 4151 must hold a certificate of authority issued under that chapter to provide those functions under this chapter for an insurance carrier. Added by Acts 2007, 80th Leg., ch. 1176, § 2.02, eff. Sept. 1, 2007.
4201.207
(a) Unless precluded or modified by contract, a utilization review agent shall reimburse a health care provider for the reasonable costs of providing medical information in writing, including the costs of copying and transmitting requested patient records or other documents. (b) A health care provider’s charges for providing medical information to a utilization review agent […]
4203.001
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 […]
4202.007
The commissioner shall provide ongoing oversight of the independent review organizations to ensure continued compliance with this chapter and the standards and rules adopted under this chapter. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4202.008
An independent review organization may not be a subsidiary of, or in any way owned or controlled by, a payor or a trade or professional association of payors. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4202.009
Information that reveals the identity of a physician or other individual health care provider who makes a review determination for an independent review organization is confidential. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4202.010
(a) An independent review organization conducting an independent review under Subchapter I, Chapter 4201, is not liable for damages arising from the review determination made by the organization. (b) This section does not apply to an act or omission of the independent review organization that is made in bad faith or that involves gross negligence. […]
4202.006
The commissioner shall charge payors fees in accordance with this chapter as necessary to fund the operations of independent review organizations. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4202.001
In this chapter, “payor” has the meaning assigned by Section 4201.002. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4201.603
If the commissioner determines that a utilization review agent, health maintenance organization, insurer, or other person or entity conducting utilization review has violated or is violating this chapter, the commissioner may: (1) impose a sanction under Chapter 82; (2) issue a cease and desist order under Chapter 83; or (3) assess an administrative penalty under […]