| (a) The commissioner may conduct an on-site examination
at the applicant's primary office as a requirement of applying for
a certificate of registration.
(b) The commissioner may conduct examinations of an
IRO as often as the commissioner deems necessary to determine compliance
with Insurance Code Chapter 4202 and this chapter, including on renewal
of the certificate of registration.
(c) The following documents must be available for review
during an examination at the primary office of the IRO located within
this state:
(1) the information required in §12.103 of this
chapter;
(2) credentialing files;
(3) case decisions files;
(4) a list of personnel who are available at the IRO's
primary office 40 hours a week during normal business hours in both
Central and Mountain time zones;
(5) a list of directors, officers, and executives and
owners or shareholders, or if the IRO is publicly held, owners or
shareholders of more than 5 percent of any of the IRO's stock or options
as described by Insurance Code §4202.004(a)(1);
(6) a chart showing the internal organizational structure
of the IRO management and administrative staff;
(7) a chart showing the contractual relationships and
arrangements of the IRO, as described in §12.103 of this chapter;
and
(8) any other documents related to the operation of
the IRO.
(d) The owner and IRO staff, including the CEO, medical
director, and operations staff, must be available at the IRO's primary
office during the on-site examination to answer all questions regarding
the IRO's operations, produce documents, and demonstrate to the examiner
the operations of the IRO.
|
| Source Note: The provisions of this §12.106 adopted to be effective November 26, 1997, 22 TexReg 11363; amended to be effective December 26, 2010, 35 TexReg 11281; amended to be effective July 7, 2015, 40 TexReg 2538 |
