Sec. 4201.457. APPEAL DECISIONS. A specialty utilization review agent shall comply with the requirement that a physician or other health care provider who makes the decision in an appeal of an adverse determination must be of the same or a similar specialty as the health care provider who would typically manage the specialty condition, procedure, or treatment under review in the appeal.
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 J. Specialty Utilization Review Agents
Section 4201.452. Inapplicability of Certain Other Law
Section 4201.453. Utilization Review Plan
Section 4201.454. Utilization Review Under Direction of Provider of Same Specialty
Section 4201.456. Opportunity to Discuss Treatment Before Adverse Determination