1. (a) Personnel employed by or under contract with the independent review organization to perform independent review shall be appropriately trained and qualified and, if applicable, currently licensed, registered, or certified. Such personnel shall be currently involved in an active practice. An exception to the active practice requirement shall be the medical director of the independent review organization. Personnel who obtain information directly from a physician, dentist, or other health care provider, either orally or in writing, and who are not physicians or dentists, shall be nurses, physician assistants, or health care providers qualified to provide the service requested by the provider. This provision shall not be interpreted to require such qualifications for personnel who perform clerical or administrative tasks.
2. (b) The independent review organization is required to provide to the commissioner the number, type, and minimum qualifications of the personnel either employed or under contract to perform the independent review. Independent review organizations are required to adopt written procedures used to determine whether physicians or other health care providers utilized by the independent review organization are licensed, qualified, in good standing, and appropriately trained, and maintain records on such. In addition, the independent review organization is required to maintain complete profiles of anyone conducting independent review. Such profiles are required to include all information required by the department in its application form and to be kept current and made available for review by the department and TDI-DWC upon request.
3. (c) An independent review organization shall be under the direction of a physician currently licensed and in good standing to practice medicine by a state licensing agency in the United States.

4. (d) The independent review organization is required to provide to the department a copy of the applicant's credentialing policies and procedures, including:

   1. (1) a description of the categories and qualifications of persons employed or under contract to perform independent review as described in this section;
   2. (2) copies of policies and procedures for orientation and training of persons who perform independent review, and evidence that the applicant meets any applicable provisions of this chapter relating to the qualifications of independent review organizations or the performance of independent review.
5. (e) Notwithstanding subsections (c) and (d) of this section, a physician, dentist, or other person who performs independent review whose license has been revoked by any state licensing agency in the United States is not eligible to direct or conduct independent review.
6. (f) Notwithstanding subsection (c) of this section, an independent review organization that performs independent review of a health care service provided under the Labor Code Title 5 or the Insurance Code Chapter 1305 shall comply with the licensing and professional specialty requirements for personnel performing independent review as provided by the Labor Code §§408.0043 - 408.0045 and 413.031; the Insurance Code §1305.355; and Chapters 133 and 180 of this title (relating to General Medical Provisions and Monitoring and Enforcement).

Source Note:The provisions of this §12.202 adopted to be effective November 26, 1997, 22 TexReg 11363; amended to be effective December 26, 2010, 35 TexReg 11281.