(a) In this section, "accessible" means publicly available
and capable of being found and read without impediment. Usernames
and passwords cannot be required to view the information.
(b) A managed care organization (MCO) must maintain
on its public-facing website the MCO's criteria and policy for prior
authorizations and website links to any prior authorization request
forms the provider uses.
(c) The MCO must maintain the following items on its
website in an easily searchable and accessible format.
(1) Applicable timelines for prior authorization requirements,
including:
(A) the timeframe in which the MCO must make a determination
on a prior authorization request;
(B) a description of the notice the MCO provides to
a provider or member regarding the documentation required to complete
a prior authorization determination; and
(C) the deadline by which the MCO must submit the notice
described in subparagraph (B) of this paragraph.
(2) An accurate and up-to-date catalogue of coverage
criteria and prior authorization requirements, including:
(A) the effective date of a prior authorization requirement,
if the requirement is first imposed on or after September 1, 2019;
(B) a list or description of any supporting or supplemental
documentation necessary to obtain prior authorization for a specified
service; and
(C) the date and results of each annual review of the
MCO's prior authorization requirements as required by Texas Government
Code §533.00283(a).
(3) The process and contact information for a provider
or member to contact the MCO to:
(A) clarify prior authorization requirements; and
(B) obtain assistance in submitting a prior authorization
request.
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