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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 28. INSURANCE |
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PART 1. TEXAS DEPARTMENT OF INSURANCE |
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CHAPTER 12. INDEPENDENT REVIEW ORGANIZATIONS |
| SUBCHAPTER A. GENERAL PROVISIONS |
| § 12.1. Statutory Basis |
| § 12.2. Severability Clause |
| § 12.3. Effect of Chapter |
| § 12.4. Applicability |
| § 12.5. Definitions |
| § 12.6. Independent Review of Adverse Determinations of Health Care Provided Under Labor Code Title 5 or Insurance Code Chapter 1305 |
| SUBCHAPTER B. CERTIFICATE OF REGISTRATION FOR INDEPENDENT REVIEW ORGANIZATIONS |
| § 12.101. Certificate of Registration for Independent Review |
| § 12.102. IRO Application Form |
| § 12.103. Information Required in Original Application for Certificate of Registration |
| § 12.104. Review of Original Application |
| § 12.105. Revisions During Review Process |
| § 12.106. Examinations |
| § 12.107. Withdrawal of an Original Application Before Granting a Certificate of Registration and Subsequent Renewal Applications |
| § 12.108. Renewal of Certificate of Registration |
| § 12.109. Appeal of Denial of Application or Renewal |
| § 12.110. Effect of Sale or Transfer of Ownership of an Independent Review Organization |
| § 12.111. Regulatory Requirements Subsequent to a Certificate of Registration |
| SUBCHAPTER C. GENERAL STANDARDS OF INDEPENDENT REVIEW |
| § 12.201. Independent Review Plan |
| § 12.202. Personnel and Credentialing |
| § 12.203. Conflicts of Interest Prohibited |
| § 12.204. Prohibitions of Certain Activities and Relationships of Independent Review Organizations and Individuals or Entities Associated with Independent Review Organizations |
| § 12.205. Independent Review Organization Contact with and Receipt of Information from Health Care Providers and Patients |
| § 12.206. Notice of Determinations Made by Independent Review Organizations |
| § 12.207. Independent Review Organization Telephone Access |
| § 12.208. Confidentiality |
| SUBCHAPTER D. ENFORCEMENT OF INDEPENDENT REVIEW STANDARDS |
| § 12.301. Complaints, Oversight, and Information |
| § 12.302. Administrative Violations |
| § 12.303. Surrender of Certificate of Registration |
| SUBCHAPTER E. FEES AND PAYMENT |
| § 12.401. Fees |
| § 12.402. Classification of Specialty |
| § 12.403. Fee Amounts |
| § 12.404. Payment of Fees |
| § 12.405. Failure To Pay Invoice |
| § 12.406. Application and Renewal of Certificate of Registration Fees |
| SUBCHAPTER F. RANDOM ASSIGNMENT OF INDEPENDENT REVIEW ORGANIZATIONS |
| § 12.501. Requests for Independent Review |
| § 12.502. Random Assignment |
| SUBCHAPTER G. INDEPENDENT REVIEW OF PREAUTHORIZATION EXEMPTIONS |
| § 12.601. Preauthorization Exemptions |