Texas Insurance Code 4201.355 – Acknowledgment of Appeal
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(a) The procedures for appealing an adverse determination must provide that, within five working days from the date the utilization review agent receives the appeal, the agent shall send to the appealing party a letter acknowledging the date of receipt.
(b) The letter must also include a list of:
(1) the procedures required by this subchapter; and
(2) the documents that the appealing party must submit for review.
Terms Used In Texas Insurance Code 4201.355
- 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.
(c) When a utilization review agent receives an oral appeal of an adverse determination, the agent shall send a one-page appeal form to the appealing party.