Utilization Review

Sec. 1272.060. UTILIZATION REVIEW. A 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. Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.004, eff. April 1, 2009.