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At a Glance:
Section:
10.101
Title:
General Standards for Utilization Review and Retrospective Review

§ 10.101

General Standards for Utilization Review and Retrospective Review

(a) Screening criteria used for utilization review and retrospective review related to a workers' compensation health care network must be consistent with the network's treatment guidelines, return-to-work guidelines, and individual treatment protocols.

(b) The carrier's utilization review program and retrospective review program must include a process for a treating doctor or specialist to request approval from the network for deviation from the treatment guidelines, return-to-work guidelines, and individual treatment protocols where required by the particular circumstances of an employee's injury.

The provisions of this § 10.101 adopted to be effective December 5, 2005, 30 TexReg 8099.

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