- (a) All independent review organizations (IROs) 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. IROs 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.
- (b) This chapter is effective on July 7, 2015. Unless otherwise provided, this chapter applies to all requests for independent review filed with the department on or after July 7, 2015. All independent reviews filed with the department before July 7, 2015, will 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; amended to be effective July 7, 2015, 40 TexReg 2538.