| (a) The department will randomly assign each request
for independent review to an IRO and will notify the utilization review
agent and the health insurance carrier, health maintenance organization,
managed care entity, or other payor requesting the independent review,
the IRO, the patient or a representative of the patient, and the provider
of record of the assignment.
(b) The department will screen payors and utilization
review agents for potential conflicts of interest with the IRO before
making an assignment to the IRO. The IRO must screen its physicians
and other providers conducting independent review for potential conflicts
of interest. The department has the discretion to determine whether
conflicts exist.
(c) IROs will be added to the list from which random
assignments for independent reviews are made in order of the date
of issuance of the certificate of registration by the department.
(d) The department will randomly assign IROs chronologically
from the list of IROs, with ultimate assignment to the first in line
with no apparent conflicts of interest.
(e) Assignment of an independent review to an IRO moves
the IRO receiving the assignment to the bottom of the assignment list.
(f) Independent reviews will not be assigned:
(1) to an IRO during the 30 days before the anniversary
date of the issuance of the IRO's certificate of registration unless
the completed application for renewal of its certificate of registration
and the application fee have been received by the department; or
(2) during the time that an IRO has surrendered its
certificate of registration under §12.303 of this chapter and
Insurance Code §4202.002(c)(2)(B).
(g) Nonselection for presence of conflicts of interest
does not move the IRO to the bottom of the assignment list. The IRO
retains its chronological position until selected for independent
review.
|
| Source Note: The provisions of this §12.502 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 |
