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At a Glance:
Medical Quality Review Process

§ 180.68

Medical Quality Review Process

(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) certification and recertification of designated doctors;

(2) performance based oversight;

(3) administrative violations that do not require an expert medical opinion; or

(4) complaints regarding professionalism that do not require an expert medical opinion.

(b) A complaint must be documented in accordance with the provisions of § 180.2 of this title (relating to Filing a Complaint).

(c) Nothing in this subchapter prevents referrals of complaints to another licensing or law enforcement authority.

The provisions of this §180.68 adopted to be effective January 1, 2013, 37 TexReg 8839.

End of Document