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