1. (a) The division of compliance and practices (the division) shall review and audit the records of insurance carriers, as that term is defined by the Texas Workers' Compensation Act (the Act), §1.03(28), the carrier's agents, and those with whom the carrier has contracted to provide, review, or monitor services under the Act, for compliance with the Act and rules of the commission.
2. (b) The division shall conduct such performance review at the offices of the insurance carrier, the carrier's agents, or those with whom the carrier has contracted to provide, review, or monitor services under the Act.
3. (c) The division shall coordinate its reviews with the division of medical review for medical compliance issues.

4. (d) The division shall provide reasonable notice in advance of any performance review. That notice shall:

   1. (1) be in writing;
   2. (2) be sent at least 10 calendar days before the review is to be performed;
   3. (3) specify the information that must be made available;
   4. (4) list the names and phone numbers of commission staff involved in the review; and
   5. (5) specify the date, time, location, and conditions of the review.

5. (e) The insurance carrier shall designate a contact person at each claim handling location to coordinate the review. That contact person shall:

   1. (1) provide reasonable access to requested personnel and information;
   2. (2) respond to reasonable needs of reviewers on-site or to telephone inquiries by reviewers; and
   3. (3) be familiar with the insurance carrier's claim handling procedures and recordkeeping systems.
6. (f) The insurance carrier, upon request, shall make available for review claim files as specified by the division.
7. (g) Written findings of the review will be provided to the insurance carrier at the time of the review or within 10 days after the review is completed.
8. (h) The insurance carrier may prepare and file with the division of compliance and practices a management response to the performance review findings. The response may include proposed corrective actions.
9. (i) The division shall provide the State Board of Insurance with a copy of all performance review findings and the insurance carrier's response, if any.
10. (j) Except to a governmental entity, the commission shall submit a bill to the insurance carrier for the actual expenses associated with the review within 10 days after the review is completed.
11. (k) The insurance carrier shall submit payment by check, made payable to the order of the commission, for the expenses within 40 days after the review is completed. Payment may be delivered in person or by mail to the commission in Austin.

Source Note:The provisions of this §180.3 adopted to be effective July 29, 1991, 16 TexReg 3940.