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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 19LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
SUBCHAPTER UUTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE
RULE §19.2008On-Site Review by a URA

(a) Identification of URAs. If a URA's staff member is conducting an on-site or off-site review, each staff member must provide his or her name, the name of his or her organization, photo identification, and a URA identification card with the certification or registration number assigned by TDI when requested by an individual, including an injured employee or health care provider.

(b) On-site review. For on-site review conducted at a health care facility, a URA:

  (1) must ensure that on-site review staff:

    (A) register with the appropriate contact individual, if available, prior to requesting any clinical information or assistance from health care facility staff; and

    (B) wear appropriate health care facility supplied identification tags while on the health care facility premises;

  (2) must agree, if so requested, that the medical records remain available in the designated areas during the on-site review and that reasonable health care facility administrative procedures will be followed by on-site review staff to avoid disrupting health care facility operations or injured employee care. The procedures, however, should not obstruct or limit the ability of the URA to efficiently conduct the necessary review.


Source Note: The provisions of this §19.2008 adopted to be effective February 20, 2013, 38 TexReg 892

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