(a) Personnel employed by or under contract with a utilization review agent to perform utilization review must be appropriately trained and qualified and meet the requirements of this chapter and other applicable law, including applicable licensing requirements.
(b) Personnel, other than a physician licensed to practice medicine, who obtain oral or written information directly from a patient’s physician or other health care provider regarding the patient’s specific medical condition, diagnosis, or treatment options or protocols must be a nurse, physician assistant, or other health care provider qualified to provide the requested service.

Terms Used In Texas Insurance Code 4201.252

  • Contract: A legal written agreement that becomes binding when signed.
  • Written: includes any representation of words, letters, symbols, or figures. See Texas Government Code 311.005

(c) This section may not be interpreted to require personnel who perform clerical or administrative tasks to have the qualifications prescribed by this section.