Texas Administrative Code
Title 28 - INSURANCE
Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
Chapter 42 - MEDICAL BENEFITS
Subchapter D - DISPUTE RESOLUTION
Section 42.309 - Payment for the Review

Universal Citation: 28 TX Admin Code ยง 42.309

Current through Reg. 49, No. 38; September 20, 2024

(a) The board shall set reasonable fees for reviewing fee and utilization disputes. The board may adjust these fees periodically, as necessary.

(b) The review fee shall be paid by check or money order, payable to Industrial Accident Board.

(c) The carrier, whether requester or respondent, shall be responsible to pay for the review, unless the board has found that the provider has overutilized the board's review system.

(d) A provider shall be found to have overutilized the board's review system after three separate disputes involving the provider have been presented to the board for review, and have been resolved by the board against the provider within a 12-month period. The board will notify a provider when such finding is made, and shall maintain a record of such findings. In all subsequent reviews of that provider's bills, the provider, whether requester or respondent, shall be responsible to pay for the review.

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