Subject to the notice requirements of §19.2010 of this title (relating to Notice of Determinations Made by Utilization Review Agents, Excluding Retrospective Review), in any instance where the utilization review agent is questioning whether the health care is medically reasonable and necessary, the health care provider who ordered the services shall be afforded a reasonable opportunity to discuss the plan of treatment for the injured employee and the clinical basis for the utilization review agent's decision with the appropriate doctor or health care provider performing the review, prior to issuance of an adverse determination. The utilization review agent shall have written procedures describing how the opportunity is afforded.

Source Note:The provisions of this §19.2011 adopted to be effective September 20, 1998, 23 TexReg 9560.