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TITLE 28INSURANCE
PART 2TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
CHAPTER 180MONITORING AND ENFORCEMENT
SUBCHAPTER CMEDICAL QUALITY REVIEW PANEL
RULE §180.68Medical Quality Review Process
(a) The medical quality review process is medical case review initiated on the basis of complaints, plan-based audits, or monitoring as a result of a consent order and performed in accordance with criteria adopted under Labor Code §413.05115. The medical quality review process does not include medical case review performed for the purpose of:

  (1) certification and renewal of designated doctors;

   (2) performance-based oversight;

   (3) administrative violations that do not require an expert medical opinion; or

   (4) complaints about professionalism that do not require an expert medical opinion.

 (b) A complaint must be documented in accordance with the provisions of §180.2 of this title (relating to Filing a Complaint).

 (c) Nothing in this subchapter prevents referrals of complaints to another licensing or law enforcement authority.
Source Note: The provisions of this §180.68 adopted to be effective January 1, 2013, 37 TexReg 8839; amended to be effective August 22, 2023, 48 TexReg 4484

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