Texas Statutes
Subtitle A - Texas Workers' Compensation Act
Chapter 413 - Medical Review

Section 413.008. Information From Insurance Carriers; Administrative Violation - Sec. 413.008. INFORMATION FROM INSURANCE CARRIERS; ADMINISTRATIVE VIOLATION. (a) On...

Subchapter B. Medical Services and Fees

Section 413.011. Reimbursement Policies and Guidelines; Treatment Guidelines and Protocols - Sec. 413.011. REIMBURSEMENT POLICIES AND GUIDELINES; TREATMENT GUIDELINES AND PROTOCOLS....

Section 413.0111. Processing Agents - Sec. 413.0111. PROCESSING AGENTS. The rules adopted by the commissioner...

Section 413.0112. Reimbursement of Federal Military Treatment Facility - Sec. 413.0112. REIMBURSEMENT OF FEDERAL MILITARY TREATMENT FACILITY. (a) In...

Section 413.0115. Requirements for Certain Voluntary or Informal Networks - Sec. 413.0115. REQUIREMENTS FOR CERTAIN VOLUNTARY OR INFORMAL NETWORKS. (a)...

Section 413.012. Medical Policy and Guideline Updates Required - Sec. 413.012. MEDICAL POLICY AND GUIDELINE UPDATES REQUIRED. The medical...

Section 413.013. Programs - Sec. 413.013. PROGRAMS. The commissioner by rule shall establish: (1)...

Section 413.014. Preauthorization Requirements; Concurrent Review and Certification of Health Care - Sec. 413.014. PREAUTHORIZATION REQUIREMENTS; CONCURRENT REVIEW AND CERTIFICATION OF HEALTH...

Section 413.0141. Initial Pharmaceutical Coverage - Sec. 413.0141. INITIAL PHARMACEUTICAL COVERAGE. The commissioner may by rule...

Section 413.015. Payment by Insurance Carriers; Audit and Review - Sec. 413.015. PAYMENT BY INSURANCE CARRIERS; AUDIT AND REVIEW. (a)...

Section 413.016. Payments in Violation of Medical Policies and Fee Guidelines - Sec. 413.016. PAYMENTS IN VIOLATION OF MEDICAL POLICIES AND FEE...

Section 413.017. Presumption of Reasonableness - Sec. 413.017. PRESUMPTION OF REASONABLENESS. The following medical services are...

Section 413.018. Review of Medical Care if Guidelines Exceeded - Sec. 413.018. REVIEW OF MEDICAL CARE IF GUIDELINES EXCEEDED. (a)...

Section 413.019. Interest Earned for Delayed Payment, Refund, or Overpayment - Sec. 413.019. INTEREST EARNED FOR DELAYED PAYMENT, REFUND, OR OVERPAYMENT....

Section 413.020. Division Charges - Sec. 413.020. DIVISION CHARGES. The commissioner by rule shall establish...

Section 413.021. Return-to-Work Coordination Services - Sec. 413.021. RETURN-TO-WORK COORDINATION SERVICES. (a) An insurance carrier shall,...

Section 413.022. Return-to-Work Reimbursement Program for Employers; Fund - Sec. 413.022. RETURN-TO-WORK REIMBURSEMENT PROGRAM FOR EMPLOYERS; FUND. (a) In...

Section 413.023. Information to Employers - Sec. 413.023. INFORMATION TO EMPLOYERS. (a) The division shall provide...

Section 413.024. Information to Employees - Sec. 413.024. INFORMATION TO EMPLOYEES. The division shall provide injured...

Section 413.025. Return-to-Work Goals and Assistance - Sec. 413.025. RETURN-TO-WORK GOALS AND ASSISTANCE. (a) The division shall...

Subchapter C. Dispute Resolution

Section 413.031. Medical Dispute Resolution - Sec. 413.031. MEDICAL DISPUTE RESOLUTION. (a) A party, including a...

Section 413.0311. Review of Medical Necessity Disputes; Contested Case Hearing - Sec. 413.0311. REVIEW OF MEDICAL NECESSITY DISPUTES; CONTESTED CASE HEARING....

Section 413.0312. Review of Medical Fee Disputes; Benefit Review Conference - Sec. 413.0312. REVIEW OF MEDICAL FEE DISPUTES; BENEFIT REVIEW CONFERENCE....

Section 413.032. Independent Review Organization Decision; Appeal - Sec. 413.032. INDEPENDENT REVIEW ORGANIZATION DECISION; APPEAL. (a) An independent...

Subchapter D. Health Care Providers

Section 413.041. Disclosure - Sec. 413.041. DISCLOSURE. (a) Each health care practitioner shall disclose...

Section 413.042. Private Claims; Administrative Violation - Sec. 413.042. PRIVATE CLAIMS; ADMINISTRATIVE VIOLATION. (a) A health care...

Section 413.043. Overcharging Prohibited; Offense - Sec. 413.043. OVERCHARGING PROHIBITED; OFFENSE. (a) A health care provider...

Section 413.044. Sanctions on Designated Doctor - Sec. 413.044. SANCTIONS ON DESIGNATED DOCTOR. (a) In addition to...

Subchapter E. Implementation of Commission Powers and Duties

Section 413.051. Contracts With Review Organizations and Health Care Providers - Sec. 413.051. CONTRACTS WITH REVIEW ORGANIZATIONS AND HEALTH CARE PROVIDERS....

Section 413.0511. Medical Advisor - Sec. 413.0511. MEDICAL ADVISOR. (a) The division shall employ or...

Section 413.05115. Medical Quality Review Process - Sec. 413.05115. MEDICAL QUALITY REVIEW PROCESS. (a) The division shall...

Section 413.0512. Medical Quality Review Panel - Sec. 413.0512. MEDICAL QUALITY REVIEW PANEL. (a) The medical advisor...

Section 413.05121. Quality Assurance Panel - Sec. 413.05121. QUALITY ASSURANCE PANEL. (a) The medical advisor shall...

Section 413.05122. Medical Quality Review Panel: Rules; Training - Sec. 413.05122. MEDICAL QUALITY REVIEW PANEL: RULES; TRAINING. (a) The...

Section 413.0513. Confidentiality Requirements - Sec. 413.0513. CONFIDENTIALITY REQUIREMENTS. (a) Information collected, assembled, or maintained...

Section 413.0514. Information Sharing With Occupational Licensing Boards - Sec. 413.0514. INFORMATION SHARING WITH OCCUPATIONAL LICENSING BOARDS. (a) This...

Section 413.0515. Reports of Chiropractor Violations - Sec. 413.0515. REPORTS OF CHIROPRACTOR VIOLATIONS. (a) Repealed by Acts...

Section 413.052. Production of Documents - Sec. 413.052. PRODUCTION OF DOCUMENTS. The commissioner by rule shall...

Section 413.053. Standards of Reporting and Billing - Sec. 413.053. STANDARDS OF REPORTING AND BILLING. The commissioner by...

Section 413.054. Immunity From Liability - Sec. 413.054. IMMUNITY FROM LIABILITY. (a) A person who performs...

Section 413.055. Interlocutory Orders; Reimbursement - Sec. 413.055. INTERLOCUTORY ORDERS; REIMBURSEMENT. (a) The commissioner may enter...

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Texas Statutes Subtitle A - Texas Workers' Compensation Act Chapter 413 - Medical Review

Texas Statutes
Subtitle A - Texas Workers' Compensation Act
Chapter 413 - Medical Review