| (J) other information that was required by the department
related to a request from an insurance carrier or the insurance carrier's
URA for the assignment of the IRO.
(t) Medical Fee Dispute Request. If the requestor has
an unresolved non-network fee dispute related to health care that
was found medically necessary, after the final decision of the medical
necessity dispute, the requestor may file a medical fee dispute in
accordance with §133.305 and §133.307 of this subchapter
(relating to MDR--General and MDR of Fee Disputes, respectively).
(u) First Responders. In accordance with Labor Code §504.055(d),
an appeal regarding the denial of a claim for medical benefits, including
all health care required to cure or relieve the effects naturally
resulting from a compensable injury involving a first responder will
be accelerated by the division and given priority. The party seeking
to expedite the contested case hearing or appeal must provide notice
to the division and independent review organization that the contested
case hearing or appeal involves a first responder.
(v) Texas Military Forces. In accordance with Labor
Code §501.028, the division will accelerate and give priority
to an appeal from a denial of a claim for medical benefits.
(1) This subsection applies to a claim for medical
benefits made by a member of the Texas military forces who, while
on state active duty, sustains a serious bodily injury, as defined
by Penal Code §1.07.
(2) The division will accelerate and give priority
to actions involving all health care required to cure or relieve the
effects naturally resulting from a compensable injury.
(3) The member must notify the division and IRO that
the CCH or appeal involves a member of the Texas military forces.
(w) Enforcement. The department or the division may
initiate appropriate proceedings under Chapter 12 of this title or
Labor Code, Title 5 and division rules against an independent review
organization or a person conducting independent reviews.
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| Source Note: The provisions of this §133.308 adopted to be effective December 31, 2006, 31 TexReg 10314; amended to be effective May 25, 2008, 33 TexReg 3954; amended to be effective May 31, 2012, 37 TexReg 3833; amended to be effective January 7, 2019, 44 TexReg 103; amended to be effective December 28, 2023, 48 TexReg 7999 |
