- (a) All independent review organizations performing independent reviews of adverse determinations made by utilization review agents, health insurance carriers, health maintenance organizations, and managed care entities, must comply with this chapter. Independent review organizations performing independent reviews of adverse determinations made by certified workers' compensation health care networks and workers' compensation insurance carriers must comply with this chapter, subject to §12.6 of this subchapter (relating to Independent Review of Adverse Determinations of Health Care Provided Pursuant to the Labor Code Title 5, or the Insurance Code Chapter 1305).
- (b) Except as otherwise provided, this chapter is applicable to all requests for independent review filed with the department on or after December 26, 2010. All independent reviews filed with the department prior to December 26, 2010 shall be subject to the rules in effect at the time the independent review was filed with the department.
Source Note:The provisions of this §12.4 adopted to be effective November 26, 1997, 22 TexReg 11363; amended to be effective December 26, 2010, 35 TexReg 11281.