Section 12.6 - Independent Review of Adverse Determinations of Health Care Provided Under Labor Code Title 5 or Insurance Code Chapter 1305(a) Review of the medical necessity or appropriateness of a health care service provided under Labor Code Chapter 408 or Chapter 413 must be conducted under this chapter in the same manner as reviews of utilization review decisions by health maintenance organizations.(b) Notwithstanding subsection (a) of this section, for independent review of adverse determinations of health care provided under Labor Code Title 5 or Insurance Code Chapter 1305: (1) IROs and personnel conducting independent review must comply with Labor Code Title 5 and applicable TDI-DWC rules;(2) in the event of a conflict between this chapter and the Labor Code, the Labor Code controls; and(3) in the event of a conflict between this chapter and TDI-DWC rules, TDI-DWC rules control.28 Tex. Admin. Code § 12.6
The provisions of this §12.6 adopted to be effective December 26, 2010, 35 TexReg 11281; Amended by Texas Register, Volume 40, Number 19, May 8, 2015, TexReg 2558, eff. 7/7/2015