Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 12 - INDEPENDENT REVIEW ORGANIZATIONS
Subchapter F - RANDOM ASSIGNMENT OF INDEPENDENT REVIEW ORGANIZATIONS
Section 12.502 - Random Assignment
Current through Reg. 50, No. 13; March 28, 2025
(a) The department will randomly assign each request for independent review to an IRO and will notify the utilization review agent and the health insurance carrier, health maintenance organization, managed care entity, or other payor requesting the independent review, the IRO, the patient or a representative of the patient, and the provider of record of the assignment.
(b) The department will screen payors and utilization review agents for potential conflicts of interest with the IRO before making an assignment to the IRO. The IRO must screen its physicians and other providers conducting independent review for potential conflicts of interest. The department has the discretion to determine whether conflicts exist.
(c) IROs will be added to the list from which random assignments for independent reviews are made in order of the date of issuance of the certificate of registration by the department.
(d) The department will randomly assign IROs chronologically from the list of IROs, with ultimate assignment to the first in line with no apparent conflicts of interest.
(e) Assignment of an independent review to an IRO moves the IRO receiving the assignment to the bottom of the assignment list.
(f) Independent reviews will not be assigned:
(g) Nonselection for presence of conflicts of interest does not move the IRO to the bottom of the assignment list. The IRO retains its chronological position until selected for independent review.