28 Tex. Admin. Code § 3.9212
Current through Reg. 49, No. 49; December 6, 2024
An issuer must perform utilization review in compliance with Insurance Code Chapter 4201 and must maintain procedures for notification, review, and appeal of an adverse determination, as defined by this section. An issuer must implement and maintain an internal appeal system for non-Medicaid adverse determinations that provides reasonable procedures for the resolution of an oral or written appeal initiated by an insured, a person acting on behalf of an insured, or an insured's provider of record concerning dissatisfaction or disagreement with an adverse determination.
28 Tex. Admin. Code § 3.9212