UTILIZATION REVIEW.
Tex. INS Code § 1272.060.
in effectA delegation agreement required by Section 1272.052 must provide that:
(1) enrollees shall receive notification at the time of enrollment of which entity is responsible for performing utilization review;
(2) the delegated entity or third party performing utilization review shall perform that review in accordance with Chapter 4201 ; and
(3) the delegated entity or third party shall forward utilization review decisions made by the entity or third party to the health maintenance organization on a monthly basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.