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TITLE 28 - INSURANCE
PART 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
CHAPTER 180 - MONITORING AND ENFORCEMENT
SUBCHAPTER C - MEDICAL QUALITY REVIEW PANEL
SECTION/RULE §180.68 - Medical Quality Review Process
Chapter Review Date 08/09/2021

(a) The medical quality review process is medical case review initiated on the basis of complaints, plan-based audits, or monitoring as a result of a consent order and performed in accordance with criteria adopted under Labor Code §413.05115. The medical quality review process does not include medical case review performed for the purpose of:(1) certification and renewal of designated doctors;(2) performance-based oversight;(3) administrative violations that do not require an expert medical opinion; or(4) complaints about professionalism that do not require an expert medical opinion.(b) A complaint must be documented in accordance with the provisions of §180.2 of this title (relating to Filing a Complaint).(c) Nothing in this subchapter prevents referrals of complaints to another licensing or law enforcement authority.

Source Note: The provisions of this §180.68 adopted to be effective January 1, 2013, 37 TexReg 8839; amended to be effective August 22, 2023, 48 TexReg 4484.

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