INSURANCE CODE

TITLE 14.  UTILIZATION REVIEW AND INDEPENDENT REVIEW

CHAPTER 4203.  PROHIBITED CONSULTANT ACTIVITIES

Sec. 4203.001.  DEFINITION.  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 (H.B. 2017), Sec. 4, eff. April 1, 2007.

Sec. 4203.002.  PROHIBITED CONSULTANT ACTIVITIES.  A member or employee of the Texas Board of Chiropractic Examiners may not act as a consultant or perform any consultant activities for an insurer or business, individual, or utilization review agent that audits chiropractic claims, charges, or services.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.