10.26
(a) A network must file a modification request with and receive approval from the department before the network may expand, eliminate, or reduce an existing service area, or add a new service area. An officer or other authorized representative of the network must verify the modification request by attesting to the truth and accuracy of […]
10.20
Except as provided by Labor Code §504.053(b)(2), concerning Election: (1) A person may not operate or perform any act of a workers’ compensation health care network in this state: (A) unless the person holds a certificate issued under Insurance Code Chapter 1305, concerning Workers’ Compensation Health Care Networks, and this chapter; or (B) except in […]
10.21
(a) A person who seeks a certificate to operate as a workers’ compensation health care network must file an application on the forms prescribed under this subchapter, accompanied by a non-refundable fee of $5,000. (b) The applicant, an officer, or other authorized representative of the applicant must verify the application by attesting to the truth […]
10.22
Each certificate application must include: (1) a description or a copy of the applicant’s basic organizational structure documents and other related documents, including organizational charts or lists that show: (A) the relationships and contracts between the applicant and any affiliates of the applicant; and (B) the internal organizational structure of the applicant’s management and administrative […]
10.23
The Commissioner will approve or disapprove an application for certification of a network in accordance with Insurance Code §1305.054, concerning Action on Application; Renewal of Certification. The provisions of this 10.23 adopted to be effective December 5, 2005, 30 TexReg 8099; amended to be effective August 2, 2022, 47 TexReg 4534.
10.1
(a) This chapter implements provisions of the Workers’ Compensation Health Care Network Act, Insurance Code Chapter 1305, concerning Workers’ Compensation Health Care Networks, and provides standards for the certification, administration, evaluation, and enforcement of the delivery of health care services to injured employees by networks contracting with or established by: (1) workers’ compensation insurance carriers; […]
10.122
(a) Any person, including a person who has attempted to resolve a complaint through a network’s complaint system process or attempted to resolve a dispute regarding whether the employee lives within the network’s service area through the insurance carrier, who is dissatisfied with resolution of the complaint, may submit a complaint to the department. (b) […]
10.200
(a) As provided in Insurance Code §1305.251, concerning Examination of Network, a network must pay to the department an examination fee set by the Commissioner for expenses directly attributable to an examination of the network conducted pursuant to Insurance Code §1305.251 or §1305.252, concerning Examination of Provider or Third Party. (b) The examination fee includes […]
10.103
Former Section, titled “Reconsideration of Adverse Determination”, had the following source: “The provisions of this §10.103 adopted to be effective December 5, 2005, 30 TexReg 8099.” Repealed by 47 TexReg 4534, effective August 2, 2022.
10.104
(a) Requirements for independent review of an adverse determination are governed by Insurance Code Chapter 1305, concerning Workers’ Compensation Health Care Networks, and department and Division of Workers’ Compensation rules, including Chapter 10, Subchapter F, of this title (relating to Utilization Review), Chapter 12 of this title (relating to Independent Review Organizations), Chapter 19 of […]