1. (a) A utilization review agent shall notify the injured employee, their representative and the treating doctor or the treating doctor's designated representative (e.g., referred health care providers or health care facilities) of a determination made in a utilization review.
2. (b) The notification and time frames for notification required by this section must be made in accordance with TWCC rules contained in Chapter 134, Subchapter G of this title (relating to Treatments and Services Requiring Preauthorization).

3. (c) Notification of adverse determination by the utilization review agent must include:

   1. (1) the principal reasons for the adverse determination;
   2. (2) the clinical basis for the adverse determination;
   3. (3) a description or the source of the screening criteria that were utilized as guidelines in making the determination; and
   4. (4) a description of the procedure for the complaint process to the Department and appeal process to TWCC.

Source Note:The provisions of this §19.2010 adopted to be effective September 20, 1998, 23 TexReg 9560.