19.2011
(a) Appeal of prospective or concurrent review adverse determinations. Each URA must comply with its written procedures for appeals. The written procedures for appeals must comply with Insurance Code Chapter 4201, Subchapter H, concerning Appeal of Adverse Determination, and must include the following provisions: (1) For workers’ compensation network coverage, a URA must include in […]
19.2012
(a) A URA must have appropriate personnel reasonably available by toll-free telephone at least 40 hours per week during normal business hours in both Central Time and Mountain Time, to discuss an injured employee’s care and to respond to telephone review requests. (b) A URA must have procedures that the URA will implement when responding […]
19.2013
(a) Confidentiality requirements. To ensure confidentiality, a URA must, when contacting a physician’s, doctor’s, or other health care provider’s office, provide its certification number, name, and professional qualifications. (1) If requested by the physician, doctor, or other health care provider, the URA must present written documentation that it is acting as an agent of the […]
19.2015
(a) A fraudulent or deceptive act or omission in obtaining, attempting to obtain, or use of certification or registration as a URA is a violation of Insurance Code Chapter 4201. (b) The commissioner’s authority under this subchapter is in addition to any other authority to enforce a sanction, penalty, fine, forfeiture, denial, suspension, or revocation […]
19.2016
(a) Application. To be certified or registered as a specialty URA, an applicant must submit to TDI the application, information, and fee required in §19.2004 of this title (Certification or Registration of URAs). (b) Same specialty required. A specialty URA must conduct utilization review under the direction of a health care provider who is of […]
19.2017
(a) Life-threatening conditions. (1) Notification for life-threatening conditions. For life-threatening conditions, notification of an adverse determination by a URA must comply with: (A) Section 134.600 of this title (relating to Preauthorization, Concurrent Review, and Voluntary Certification of Health Care) for workers’ compensation non-network coverage; (B) Insurance Code § 1305.353 and §10.102 of this title (relating […]
19.2018
Repealed eff. February 20, 2013
19.2019
Repealed eff. February 20, 2013
19.2020
Repealed eff. February 20, 2013
19.2021
Repealed eff. February 20, 2013