Texas § 4201.402 INFORMATION PROVIDED TO INDEPENDENT REVIEW ORGANIZATION.

Texas Statutes

§ 4201.402 — INFORMATION PROVIDED TO INDEPENDENT REVIEW ORGANIZATION.

Texas § 4201.402

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Bluebook

Tex. Insurance Code Code Ann. § 4201.402 (2026).

Text

Sec. 4201.402. INFORMATION PROVIDED TO INDEPENDENT REVIEW ORGANIZATION.

(a)Not later than the third business day after the date a utilization review agent receives a request for independent review, the agent shall provide to the appropriate independent review organization:

(1)a copy of:

(A)any medical records of the enrollee that are relevant to the review;

(B)any documents used by the plan in making the determination to be reviewed;

(C)the written notification described by Section 4201.359 ; and

(D)any documents and other written information submitted to the agent in support of the appeal; and

(2)a list of each physician or other health care provider who:

(A)has provided care to the enrollee; and

(B)may have medical records relevant to the appeal.

(b)A utilization review agent m

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Sec. 4201.402. INFORMATION PROVIDED TO INDEPENDENT REVIEW ORGANIZATION. (a) Not later than the third business day after the date a utilization review agent receives a request for independent review, the agent shall provide to the appropriate independent review organization:
(1) a copy of:
(A) any medical records of the enrollee that are relevant to the review;
(B) any documents used by the plan in making the determination to be reviewed;
(C) the written notification described by Section 4201.359 ; and
(D) any documents and other written information submitted to the agent in support of the appeal; and
(2) a list of each physician or other health care provider who:
(A) has provided care to the enrollee; and
(B) may have medical records relevant to the appeal.
(b) A utilization review agent may provide confidential information in the custody of the agent to an independent review organization, subject to rules and standards adopted by the commissioner under Chapter 4202 .