1 Tex. Admin. Code, Chapter 371, Subchapter C – Utilization Review | Midpage

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Texas Administrative Code

Subchapter C

1 Tex. Admin. Code, Chapter 371, Subchapter C

Utilization Review

Texas Secretary of State

371.200Inpatient Hospital Utilization Review Program 371.201Case Selection Process 371.203TMRP Review Process 371.204Hospital Screening Criteria for TMRP, TEFRA, and Facility-Specific Per Diem Methodology Reviews 371.206Denials and Recoupments for TMRP, TEFRA Hospitals, and Facility-Specific Per Diem Methodology Reviews 371.208Appeals Related to Utilization Review Department Review Decisions 371.210Inpatient Utilization Review for Hospitals Reimbursed Under TMRP and TEFRA Principles of Reimbursement and Facility-Specific Per Diem Methodology Reviews 371.212Utilization Review of Nursing Facilities 371.214HHSC-Approved Online RUG or Other HHSC-Required Training Course 371.216Nursing Facility Clinical Records 371.218Onsite and Desk Utilization Reviews of Nursing Facilities 371.220Exit Conferences 371.222Reconsideration of Utilization Review Results 371.224Appeals of Reconsideration Results 371.226Calculation of Overpayments and Underpayments 371.228Recoveries 371.230Waiver of Extrapolation