Texas Register
TITLE 1 ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 371MEDICAID FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER CUTILIZATION REVIEW
RULE §371.208Appeals Related To Utilization Review Department Review Decisions
ISSUE 03/21/2003
ACTION Final/Adopted
Preamble Texas Admin Code Rule
If a hospital receives notification from the Texas Health and Human Services Commission (HHSC) Utilization Review Department of an adverse decision regarding medical necessity of admission, days of stay, diagnosis related group (DRG) validation, or a final technical denial, the hospital may appeal to the HHSC Resolution Services, Medical/Administrative Appeals Unit. The written notification of adverse decision will set out the time frame within which the appeal must be received by the HHSC Resolution Services, Medical/Administrative Appeals Unit.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on March 10, 2003

TRD-200301655

Steve Aragón

General Counsel

Texas Health and Human Services Commission

Effective date: March 30, 2003

Proposal publication date: October 4, 2002

For further information, please call: (512) 424-6576

 

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