Texas Register
TITLE 28 INSURANCE
PART 2TEXAS WORKERS' COMPENSATION COMMISSION
CHAPTER 133GENERAL MEDICAL PROVISIONS
SUBCHAPTER DDISPUTE AND AUDIT OF BILLS BY INSURANCE CARRIERS
RULE §133.308Medical Dispute Resolution by Independent Review Organizations
ISSUE 03/05/2004
ACTION Proposed
Preamble Texas Admin Code Rule
(a)Applicability. This rule is to be applied as follows.

  (1)This rule applies to the independent review of prospective or retrospective medical necessity disputes (a review of health care requiring preauthorization or concurrent review, or retrospective review of health care provided) for which the dispute resolution request was filed on or after January 1, 2003. Dispute resolution requests filed prior to January 1, 2003 shall be resolved in accordance with the rules in effect at the time the request was filed. When applicable, retrospective medical necessity disputes shall be governed by the provisions of §133.309 of this title (relating to Alternate Medical Necessity Dispute Resolution by Case Review Doctor), effective for dispute resolution requests filed on or after August 1, 2004. All independent review organizations (IROs) [(IRO's) ] performing reviews of health care under the Texas Workers' Compensation Act (the Act), regardless of where the independent review activities are based, shall comply with this rule.

  (2)(No change.)

 (b) - (y) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 23, 2004

TRD-200401267

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Earliest possible date of adoption: April 4, 2004

For further information, please call: (512) 804-4287

 

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