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Chapter 413

Medical Review

Subchapter A. General Provisions

413.002 Medical Review 413.003 Authority to Contract 413.004 Coordination with Providers 413.006 Advisory Committees 413.007 Information Maintained by Division 413.008 Information from Insurance Carriers; Administrative Violation

Subchapter B. Medical Services and Fees

413.011 Reimbursement Policies and Guidelines; Treatment Guidelines and Protocols 413.0111 Processing Agents 413.0112 Reimbursement of Federal Military Treatment Facility 413.0115 Requirements for Certain Voluntary or Informal Networks 413.012 Medical Policy and Guideline Updates Required 413.013 Programs 413.014 Preauthorization Requirements; Concurrent Review and Certification of Health Care 413.0141 Initial Pharmaceutical Coverage 413.015 Payment by Insurance Carriers; Audit and Review 413.016 Payments in Violation of Medical Policies and Fee Guidelines 413.017 Presumption of Reasonableness 413.018 Review of Medical Care If Guidelines Exceeded 413.019 Interest Earned for Delayed Payment, Refund, or Overpayment 413.020 Division Charges 413.021 Return-to-Work Coordination Services 413.022 Return-to-Work Reimbursement Program for Employers; Fund 413.023 Information to Employers 413.024 Information to Employees 413.025 Return-to-Work Goals and Assistance

Subchapter C. Dispute Resolution

413.031 Medical Dispute Resolution 413.0311 Review of Medical Necessity Disputes; Contested Case Hearing 413.0312 Review of Medical Fee Disputes; Benefit Review Conference 413.032 Independent Review Organization Decision; Appeal

Subchapter D. Health Care Providers

413.041 Disclosure 413.042 Private Claims; Administrative Violation 413.043 Overcharging Prohibited; Offense 413.044 Sanctions on Designated Doctor

Subchapter E. Implementation of Commission Powers and Duties

413.051 Contracts with Review Organizations and Health Care Providers 413.0511 Medical Advisor 413.05115 Medical Quality Review Process 413.0512 Medical Quality Review Panel 413.05121 Quality Assurance Panel 413.05122 Medical Quality Review Panel: Rules; Training 413.0513 Confidentiality Requirements 413.0514 Information Sharing with Occupational Licensing Boards 413.0515 Reports of Chiropractor Violations 413.052 Production of Documents 413.053 Standards of Reporting and Billing 413.054 Immunity from Liability 413.055 Interlocutory Orders; Reimbursement