Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE
Section 19.2013 - Confidentiality
Universal Citation: 28 TX Admin Code § 19.2013
Current through Reg. 50, No. 13; March 28, 2025
(a) Confidentiality requirements. To ensure confidentiality, a URA must, when contacting a physician's, doctor's, or other health care provider's office, provide its certification number, name, and professional qualifications.
(1) If requested
by the physician, doctor, or other health care provider, the URA must present
written documentation that it is acting as an agent of the insurance carrier
for the relevant injured employee.
(2) Medical records and injured employee
specific information must be maintained by a URA in a secure area with access
limited to essential personnel only.
(3) A URA must retain information generated
and obtained by the URA in the course of utilization review for at least four
years.
(4) A URA's charges for
providing a copy of recorded personal information to individuals may not exceed
10 cents per page and may not include any costs that are otherwise recouped as
part of the charge for utilization review.
(b) Written procedures on confidentiality.
(1) A URA must specify in writing the
procedures the URA will implement pertaining to confidentiality of information
received from the injured employee, the injured employee's representative, and
the physician, doctor, or other health care provider and the information
exchanged between the URA and third parties for conducting utilization review.
These procedures must specify that:
(A)
specific information received from the injured employee, the injured employee's
representative, and the physician, doctor, or other health care provider and
the information exchanged between the URA and third parties for the purpose of
conducting reviews will be considered confidential, be used by the review agent
solely for utilization review, and be shared by the URA with only those third
parties who have authority to receive the information, for example, the claim
administrator; and
(B) the URA has
procedures in place to address confidentiality, and that the URA agrees to
abide by any federal and state laws governing the issue of
confidentiality.
(2)
Summary data which does not provide sufficient information to allow
identification of individual injured employees, physicians, doctors, or other
health care providers is not considered confidential.
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.
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