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State Law
Federal Law
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Texas Labor Code - Chapter 413 Medical ReviewLegal Research Home > Texas Lawyer > Labor Code > Texas Labor Code - Chapter 413 Medical Review (a) The division shall monitor health care providers, insurance carriers, independent review organizations, and workers' compensation claimants who receive medical services to ensure the compliance ... The division may contract with a private or public entity to perform a duty or function of the division. Acts 1993, 73rd Leg., ch. 269, ... The division shall coordinate its activities with health care providers as necessary to perform its duties under this chapter. The coordination may include: (1) conducting ... The commissioner may appoint advisory committees as the commissioner considers necessary. Acts 1993, 73rd Leg., ch. 269, § 1, eff. Sept. 1, 1993. Amended by ... (a) The division shall maintain a statewide data base of medical charges, actual payments, and treatment protocols that may be used by: (1) the commissioner ... (a) On request from the division for specific information, an insurance carrier shall provide to the division any information in the carrier's possession, custody, or ... (a) The commissioner shall adopt health care reimbursement policies and guidelines that reflect the standardized reimbursement structures found in other health care delivery systems with ... The rules adopted by the commissioner for the reimbursement of prescription medications and services must authorize pharmacies to use agents or assignees to process claims ... The medical policies and fee guidelines shall be reviewed and revised at least every two years to reflect fair and reasonable fees and to reflect ... The commissioner by rule shall establish: (1) a program for prospective, concurrent, and retrospective review and resolution of a dispute regarding health care treatments and ... (a) In this section, "investigational or experimental service or device" means a health care treatment, service, or device for which there is early, developing scientific ... The commissioner may by rule provide that an insurance carrier shall provide for payment of specified pharmaceutical services sufficient for the first seven days following ... (a) Insurance carriers shall make appropriate payment of charges for medical services provided under this subtitle. An insurance carrier may contract with a separate entity ... (a) The division shall order a refund of charges paid to a health care provider in excess of those allowed by the medical policies or ... The following medical services are presumed reasonable: (1) medical services consistent with the medical policies and fee guidelines adopted by the commissioner; and (2) medical ... (a) The commissioner by rule shall provide for the periodic review of medical care provided in claims in which guidelines for expected or average return ... (a) Interest on an unpaid fee or charge that is consistent with the fee guidelines accrues at the rate provided by Section 401.023 beginning on ... The commissioner by rule shall establish procedures to enable the division to charge: (1) an insurance carrier a reasonable fee for access to or evaluation ... (a) An insurance carrier shall, with the agreement of a participating employer, provide the employer with return-to-work coordination services as necessary to facilitate an employee's ... Text of section effective until September 1, 2009 (a) In this section: (1) "Account" means the workers' compensation return-to-work account. (2) "Eligible employer" means ... (a) The division shall provide employers with information on methods to enhance the ability of an injured employee to return to work. The information may ... The division shall provide injured employees with information regarding the benefits of early return to work. The information must include information on how to receive ... (a) The division shall assist recipients of income benefits to return to the workforce. The division shall develop improved data sharing, within the standards of ... (a) A party, including a health care provider, is entitled to a review of a medical service provided or for which authorization of payment is ... (a) An independent review organization that conducts a review under this chapter shall specify the elements on which the decision of the organization is based. ... (a) Each health care practitioner shall disclose to the division the identity of any health care provider in which the health care practitioner, or the ... (a) A health care provider may not pursue a private claim against a workers' compensation claimant for all or part of the cost of a ... (a) A health care provider commits an offense if the person knowingly charges an insurance carrier an amount greater than that normally charged for similar ... (a) In addition to or in lieu of an administrative penalty under Section 415.021 or a sanction imposed under Section 415.023, the commissioner may impose ... (a) In this section, "health care provider professional review organization" includes an independent review organization. (b) The division may contract with a health care provider, ... (a) The division shall employ or contract with a medical advisor, who must be a doctor as that term is defined by Section 401.011. (b) ... (a) The medical advisor shall establish a medical quality review panel of health care providers to assist the medical advisor in performing the duties required ... (a) Information collected, assembled, or maintained by or on behalf of the division under Section 413.0511 or 413.0512 constitutes an investigation file for purposes of ... (a) This section applies only to information held by or for the division, the Texas State Board of Medical Examiners, and Texas Board of Chiropractic ... (a) If the division or the Texas State Board of Medical Examiners discovers an act or omission by a physician that may constitute a felony, ... The commissioner by rule shall establish procedures to enable the division to compel the production of documents. Acts 1993, 73rd Leg., ch. 269, § 1, ... The commissioner by rule shall establish standards of reporting and billing governing both form and content. Acts 1993, 73rd Leg., ch. 269, § 1, eff. ... (a) A person who performs services for the division as a designated doctor, an independent medical examiner, a doctor performing a medical case review, or ... (a) The commissioner may enter an interlocutory order for the payment of all or part of medical benefits. The order may address accrued benefits, future ... Last modified: August 10, 2007 |