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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 19. LICENSING AND REGULATION OF INSURANCE PROFESSIONALS |
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SUBCHAPTER R. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY |
SUBCHAPTER R. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY
| DIVISION 1. UTILIZATION REVIEWS |
| § 19.1701. General Provisions |
| § 19.1702. Applicability |
| § 19.1703. Definitions |
| § 19.1704. Certification or Registration of URAs |
| § 19.1705. General Standards of Utilization Review |
| § 19.1706. Requirements and Prohibitions Relating to Personnel |
| § 19.1707. URA Contact with and Receipt of Information from Health Care Providers |
| § 19.1708. On-Site Review by a URA |
| § 19.1709. Notice of Determinations Made in Utilization Review |
| § 19.1710. Requirements Prior to Issuing an Adverse Determination |
| § 19.1711. Written Procedures for Appeal of Adverse Determinations |
| § 19.1712. URA's Telephone Access |
| § 19.1713. Confidentiality |
| § 19.1714. Regulatory Requirements Subsequent to Certification or Registration |
| § 19.1715. Administrative Violations |
| § 19.1716. Specialty URA |
| § 19.1717. Independent Review of Adverse Determinations |
| § 19.1718. Preauthorization for Health Maintenance Organizations and Preferred Provider Benefit Plans |
| § 19.1719. Verification for Health Maintenance Organizations and Preferred Provider Benefit Plans |
| DIVISION 2. PREAUTHORIZATION EXEMPTIONS |
| § 19.1730. Definitions |
| § 19.1731. Preauthorization Exemption |
| § 19.1732. Notice of Preauthorization Exemption Grants, Denials, or Rescissions |
| § 19.1733. Retrospective Reviews and Appeals of Preauthorization Exemption Rescissions |