| (a) All independent review organizations (IROs) performing
independent reviews of adverse determinations made by utilization
review agents, health insurance carriers, health maintenance organizations,
and managed care entities must comply with this chapter. IROs performing
independent reviews of adverse determinations made by certified workers'
compensation health care networks and workers' compensation insurance
carriers must comply with this chapter, subject to §12.6 of this
title (relating to Independent Review of Adverse Determinations of
Health Care Provided Under Labor Code Title 5 or Insurance Code Chapter
1305).
(b) All IROs performing independent reviews of adverse
determinations regarding preauthorization exemptions made under Insurance
Code Chapter 4201, Subchapter N, concerning Exemption From Preauthorization
Requirements for Physicians and Providers Providing Certain Health
Care Services, must comply with §12.601 of this title (relating
to Preauthorization Exemptions).
|
| Source Note: The provisions of this §12.4 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; amended to be effective September 1, 2022, 47 TexReg 5117 |
