Texas Insurance Code 4201.455 – Personnel
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(a) Personnel who are employed by or under contract with a specialty utilization review agent to perform utilization review must be appropriately trained and qualified and meet the requirements of this chapter and other applicable law of this state, including applicable licensing laws.
(b) Personnel who obtain oral or written information directly from a physician or other health care provider must be a nurse, physician assistant, or other health care provider of the same specialty as the agent and who are licensed or otherwise authorized to provide the specialty health care service by a state licensing agency in the United States.
Terms Used In Texas Insurance Code 4201.455
- Contract: A legal written agreement that becomes binding when signed.
- United States: includes a department, bureau, or other agency of the United States of America. See Texas Government Code 311.005
- Written: includes any representation of words, letters, symbols, or figures. See Texas Government Code 311.005
(c) This section does not require personnel who perform only clerical or administrative tasks to have the qualifications prescribed by this section.