Texas Statutes (Last Updated: January 4, 2014) |
INSURANCE CODE |
Title 14. UTILIZATION REVIEW AND INDEPENDENT REVIEW |
Chapter 4203. PROHIBITED CONSULTANT ACTIVITIES |
Sec. 4203.001. DEFINITION
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In this chapter, "consultant" means a person who, for compensation and at the request of an insurer, business, individual, or utilization review agent:
(1) reviews, assesses, or evaluates a claim, charge, or service of another chiropractor to determine whether the claim, charge, or service is:
(A) medically necessary, reasonable, or appropriate; or
(B) recommended for payment or nonpayment; or
(2) advises an insurer or utilization review agent regarding a chiropractic charge or service or recommends to that insurer or agent guidelines for a chiropractic charge or service.
Added by Acts 2005, 79th Leg., Ch. 727 , Sec. 4, eff. April 1, 2007.