28 Tex. Admin. Code § 12.106 - Examinations
(a) The commissioner may conduct an on-site
examination at the applicant's primary office as a requirement of applying for
a certificate of registration.
(b)
The commissioner may conduct examinations of an IRO as often as the
commissioner deems necessary to determine compliance with Insurance Code
Chapter 4202 and this chapter, including on renewal of the certificate of
registration.
(c) The following
documents must be available for review during an examination at the primary
office of the IRO located within this state:
(1) the information required in §
12.103 of this chapter;
(2) credentialing files;
(3) case decisions files;
(4) a list of personnel who are available at
the IRO's primary office 40 hours a week during normal business hours in both
Central and Mountain time zones;
(5) a list of directors, officers, and
executives and owners or shareholders, or if the IRO is publicly held, owners
or shareholders of more than 5 percent of any of the IRO's stock or options as
described by Insurance Code §
4202.004(a)(1);
(6) a chart showing the internal
organizational structure of the IRO management and administrative
staff;
(7) a chart showing the
contractual relationships and arrangements of the IRO, as described in §
12.103 of this chapter;
and
(8) any other documents related
to the operation of the IRO.
(d) The owner and IRO staff, including the
CEO, medical director, and operations staff, must be available at the IRO's
primary office during the on-site examination to answer all questions regarding
the IRO's operations, produce documents, and demonstrate to the examiner the
operations of the IRO.
Notes
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