Sec. 4201.355. ACKNOWLEDGMENT OF APPEAL. (a) The procedures for appealing an adverse determination must provide that, within five working days from the date the utilization review agent receives the appeal, the agent shall send to the appealing party a letter acknowledging the date of receipt.
(b) The letter must also include a list of:
(1) the procedures required by this subchapter; and
(2) the documents that the appealing party must submit for review.
(c) When a utilization review agent receives an oral appeal of an adverse determination, the agent shall send a one-page appeal form to the appealing party.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.
Structure Texas Statutes
Title 14 - Utilization Review and Independent Review
Chapter 4201 - Utilization Review Agents
Subchapter H. Appeal of Adverse Determination
Section 4201.351. Complaint as Appeal
Section 4201.352. Written Description of Appeal Procedures
Section 4201.353. Appeal Procedures Must Be Reasonable
Section 4201.354. Persons or Entities Who May Appeal
Section 4201.355. Acknowledgment of Appeal
Section 4201.356. Decision by Physician Required; Specialty Review
Section 4201.358. Response Letter to Interested Persons