133.240
(a) An insurance carrier shall take final action after conducting bill review on a complete medical bill, or determine to audit the medical bill in accordance with §133.230 of this chapter (relating to Insurance Carrier Audit of a Medical Bill), not later than the 45th day after the date the insurance carrier received a complete […]
133.250
(a) If the health care provider is dissatisfied with the insurance carrier’s final action on a medical bill, the health care provider may request that the insurance carrier reconsider its action. If the health care provider is requesting reconsideration of a bill denied based on an adverse determination, the request for reconsideration constitutes an appeal […]
133.305
(a) Definitions. The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise. (1) First responder–As defined in Labor Code §504.055(a). (2) Lifethreatening–A disease or condition for which the likelihood of death is probable unless the course of the disease or condition is interrupted, as defined […]
133.308
(a) Applicability. The applicability of this section is as follows. (1) This section applies to the independent review of medical necessity disputes that are filed on or after June 1, 2012. Dispute resolution requests filed prior to June 1, 2012 shall be resolved in accordance with the statutes and rules in effect at the time […]
134.600
(a) The following words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise: (1) Adverse determination: A determination by a utilization review agent made on behalf of a payor that the health care services provided or proposed to be provided to an injured employee are not […]
133.4
Repealed The provisions of this §133.4 adopted to be effective July 27, 2008, 33 TexReg 5701; Repealed effective January 7, 2026, __ TexReg ____.
133.5
Repealed The provisions of this §133.5 adopted to be effective July 27, 2008, 33 TexReg 5701; Repealed effective January 7, 2026, __ TexReg ____.
133.309
Repealed The provisions of this §133.309 adopted to be effective September 12, 2004, 29 TexReg 8567; Repealed effective January 7, 2026, __ TexReg ____.
63.5
REPEALED The provisions of this §63.5 adopted to be effective November 20, 1977, 2 TexReg 4324, repealed effect January 5, 2026, __ TexReg ____.
130.102
(a) General. An injured employee is not entitled to supplemental income benefits until the expiration of the impairment income benefit period. (b) Eligibility Criteria. An injured employee who has an impairment rating of 15% or greater, who has not commuted any impairment income benefits, who has not permanently lost entitlement to supplemental income benefits and […]