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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 28. INSURANCE |
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PART 2. TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION |
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CHAPTER 42. MEDICAL BENEFITS |
| SUBCHAPTER A. GENERAL MEDICAL PROVISIONS |
| § 42.5. Applicability and Scope of Rules |
| § 42.10. Acceptance of Rules and Guidelines |
| § 42.15. Definitions |
| § 42.20. Who May Treat |
| § 42.25. Prohibited Practices |
| § 42.28. Confirmation of Coverage |
| § 42.30. Written Communications |
| § 42.33. Health Care Providers' Reporting Requirements |
| § 42.35. Required Reports: First Report |
| § 42.40. Required Reports: Subsequent Reports |
| § 42.55. Required Reports: Change of Status Reports |
| § 42.60. Required Reports: Special Reports |
| § 42.65. Changing Treating Doctors |
| § 42.75. Excess Recovery from Third Party Actions |
| § 42.78. Reports To Be Filed by the Carrier |
| § 42.80. Assignment of Medical Benefits |
| § 42.85. Voluntary Arbitration |
| § 42.90. Demand for Surgical Operation |
| § 42.95. Scars and Deformities |
| SUBCHAPTER B. MEDICAL COST EVALUATION |
| § 42.101. Purpose |
| § 42.105. Medical Fee Guideline |
| § 42.115. Pharmaceutical Fee Guideline |
| § 42.135. Liability for Covered Health Care |
| § 42.137. Utilization Review |
| § 42.140. Amount of Payment |
| § 42.145. Billing |
| § 42.155. Carrier Review of Bills |
| § 42.160. Carrier Desk Audit of Bills |
| § 42.165. Carrier On-Site Audit of Hospital Bills |
| § 42.175. Miscellaneous Covered Services |
| SUBCHAPTER D. DISPUTE RESOLUTION |
| § 42.305. Requesting Dispute Review and Resolution |
| § 42.307. Procedure for Requesting Dispute Review |
| § 42.308. Procedure for Responding to a Request for Dispute Review |
| § 42.309. Payment for the Review |
| § 42.310. Board Review and Resolution |
| § 42.315. Appeal |