28 Tex. Admin. Code § 12.6 - Independent Review of Adverse Determinations of Health Care Provided Under Labor Code Title 5 or Insurance Code Chapter 1305
(a) Review of the medical necessity or
appropriateness of a health care service provided under Labor Code Chapter 408
or Chapter 413 must be conducted under this chapter in the same manner as
reviews of utilization review decisions by health maintenance
organizations.
(b) Notwithstanding
subsection (a) of this section, for independent review of adverse
determinations of health care provided under Labor Code Title 5 or Insurance
Code Chapter 1305:
(1) IROs and personnel
conducting independent review must comply with Labor Code Title 5 and
applicable TDI-DWC rules;
(2) in
the event of a conflict between this chapter and the Labor Code, the Labor Code
controls; and
(3) in the event of a
conflict between this chapter and TDI-DWC rules, TDI-DWC rules
control.
Notes
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