1. (a) Unless approved by an injured employee and the treating doctor or modified by contract, a utilization review agent shall be prohibited from observing, participating in, recording, or otherwise being present during an injured employee's examination, treatment, procedure or therapy. In no event shall this section otherwise be construed to limit or deny contact with an injured employee or the health care provider for purposes of conducting utilization review unless otherwise specifically prohibited by law.
2. (b) Utilization review agents' staff shall identify themselves by name and by the name of their organization and, for on-site reviews, should carry picture identification and the utilization review company identification card with the certification or registration number assigned by the Texas Department of Insurance. Utilization review agents should assure that their on-site review staff register with the appropriate contact person, if available, prior to requesting any clinical information or assistance from hospital staff, and wear appropriate hospital supplied identification tags while on the premises. Utilization review agents shall agree, if so requested, that the medical records remain available in the designated areas during the on-site review, and that reasonable hospital administrative procedures shall be followed by on-site review staff so as to not disrupt hospital operations or patient care. Such procedures, however, should not obstruct or limit the ability of the utilization review agent to efficiently conduct the necessary review.

Source Note:The provisions of this §19.2009 adopted to be effective September 20, 1998, 23 TexReg 9560.