Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
Subchapter R - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY
Division 1 - UTILIZATION REVIEWS
Section 19.1708 - On-Site Review by a URA
Universal Citation: 28 TX Admin Code § 19.1708
Current through Reg. 50, No. 13; March 28, 2025
(a) Identification of URAs. If a URA's staff member is conducting an on-site or off-site review, each staff member must provide his or her name, the name of his or her organization, photo identification, and the URA identification card with the certification or registration number assigned by TDI when requested by an individual, including an enrollee or health care provider.
(b) On-site review. For on-site review conducted at a health care facility, URAs:
(1) must ensure that their on-site review
staff:
(A) register with the appropriate
contact individual, if available, prior to requesting any clinical information
or assistance from health care facility staff; and
(B) wear appropriate health care facility
supplied identification tags while on the health care facility
premises;
(2) must
agree, if so requested, that the medical records remain available in the
designated areas during the on-site review and that reasonable health care
facility administrative procedures will be followed by on-site review staff to
avoid disrupting health care facility operations or enrollee care. The
procedures, however, should not obstruct or limit the ability of the URA to
efficiently conduct the necessary review.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
