28 Tex. Admin. Code § 12.6 – Independent Review of Adverse Determinations of Health Care Provided Pursuant to the Labor Code Title 5, or the Insurance Code Chapter 1305

(a) Review of the medical necessity or appropriateness of a health care service provided under the Labor Code Chapter 408 or Chapter 413 shall be conducted under this chapter in the same manner as reviews of utilization review decisions by health maintenance organizations.
(b) Notwithstanding subsection (a) of this section, for independent review of adverse determinations of health care provided pursuant to the Labor Code Title 5 or the Insurance Code Chapter 1305:
1. (1) independent review organizations and personnel conducting independent review must comply with the Labor Code Title 5 and applicable TDI-DWC rules;
2. (2) in the event of a conflict between this chapter and the Labor Code, the Labor Code controls; and
3. (3) in the event of a conflict between this chapter and TDI-DWC rules, TDI-DWC rules control.

Source Note:The provisions of this §12.6 adopted to be effective December 26, 2010, 35 TexReg 11281.