Texas Insurance Code 4201.104 – Certification and Renewal Forms
(a) The commissioner shall promulgate forms to be filed under this subchapter for initial certification and for a renewal certificate of registration. The form for initial certification must require:
(1) the utilization review agent’s name, address, telephone number, and normal business hours;
(2) the name and address of an agent for service of process in this state;
(3) a summary of the utilization review plan;
(4) information concerning the categories of personnel who will perform utilization review for the agent;
(5) a copy of the procedures established under Subchapter H for the appeal of an adverse determination;
(6) a certification that the agent will comply with this chapter; and
(7) a copy of the procedures for resolving oral or written complaints initiated by enrollees, patients, or health care providers as required by § 4201.204.
(b) The commissioner may not require that the summary of the utilization review plan include proprietary details.
Terms Used In Texas Insurance Code 4201.104
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Service of process: The service of writs or summonses to the appropriate party.
- Written: includes any representation of words, letters, symbols, or figures. See Texas Government Code 311.005