Texas Workers' Compensation

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§ 180.68. Medical Quality Review Process

(a) The medical quality review process is medical case review initiated on the basis of complaints, plan-based audits, or monitoring as a result of a consent order and performed in accordance with criteria adopted under Labor Code § 413.05115. The medical quality review process does not include medical case review performed for the purpose of:

(1) certification and recertification of designated doctors;

(2) performance based oversight;

(3) administrative violations that do not require an expert medical opinion; or

(4) complaints regarding professionalism that do not require an expert medical opinion.

(b) A complaint must be documented in accordance with the provisions of § 180.2 of this title (relating to Filing a Complaint).

(c) Nothing in this subchapter prevents referrals of complaints to another licensing or law enforcement authority.

The provisions of this §180.68 adopted to be effective January 1, 2013, 37 TexReg 8839.

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At a Glance:

Title:

§ 180.68. Medical Quality Review Process

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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