134.250
(a) The total maximum allowable reimbursement (MAR) for a maximum medical improvement (MMI) or impairment rating (IR) examination is equal to the MMI evaluation reimbursement plus the reimbursement for the body area or areas evaluated for the assignment of an IR. The MMI or IR examination must include: (1) the examination; (2) consultation with the […]
180.2
(a) Any person may submit a complaint to the division for alleged administrative violations, except as provided in subsection (b) of this section. (b) A health care provider cannot submit a complaint about a medical billing issue if the date of service for the medical billing issue was more than 12 months before the date […]
122.100
(a) Filing. For a legal beneficiary, other than the subsequent injury fund, to receive the benefits available because of the death of an employee that results from a compensable injury, a person must file a written claim for death benefits within one year after the date of the employee’s death. (b) An insurance carrier that […]
124.8
(a) Definition. In this section, “claim for death benefits” means a claim that is filed under Chapter 122, Subchapter B, 122.100 of this title. (b) General requirements. An insurance carrier that receives a notice of death in accordance with 132.17 of this title, or a claim for death benefits must comply with all of the […]
180.64
(a) To apply to the MQRP, a person must submit an application in the form and manner required by the division demonstrating compliance with the required qualifications. The application must contain complete information as provided by subsection (b) of this section. The medical advisor and the Commissioner may select and appoint only qualified applicants to […]
180.66
The MQRP may perform medical case review for the medical advisor. Medical case review may be performed for the purposes of the medical quality review process, designated doctor certification and renewal, performance-based oversight, or any other medical case review necessary to assist the medical advisor in performing the medical advisor’s duties under the Labor Code. […]
180.68
(a) The medical quality review process is medical case review initiated on the basis of complaints, plan-based audits, or monitoring as a result of a consent order and performed in accordance with criteria adopted under Labor Code §413.05115. The medical quality review process does not include medical case review performed for the purpose of: (1) […]
180.72
(a) If the selected MQRP member has a conflict of interest in a case under medical review, that member may not review the case or serve as an arbiter. If all MQRP members in a particular health care specialty field as the subject of a medical case review have conflicts of interest in a case […]
180.76
(a) The person subject to the medical quality review process has the right: (1) to be notified that the person has been selected for the medical quality review process; (2) to be notified of the disposition of the medical quality review process; (3) to communicate with the office of the medical advisor at any time […]
180.78
Former Section, titled “Effective Date”, had the following source: “The provisions of this 180.78 adopted to be effective January 1, 2013, 37 TexReg 8839.” Repealed by 48 TexReg 4484, effective August 22, 2023.