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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 19LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
SUBCHAPTER RUTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY
DIVISION 1UTILIZATION REVIEWS
RULE §19.1708On-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 the URA identification card with the certification or registration number assigned by TDI when requested by an individual, including an enrollee or health care provider.

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

  (1) must ensure that their 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 enrollee 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 §19.1708 adopted to be effective February 20, 2013, 38 TexReg 892

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