Utilization Review

Utilization Review Agent

UTILIZATION REVIEW AGENT(URA)

• URA - Search the Utilization Review Agent Listing
  

URA CERTIFICATION Application and Attachments

• Application form including Lists of Exhibits to Application (.pdf format)
• Agent of Service of Process Certification Page (.pdf format)
• Biographical affidavit (.pdf format)
• Addendum to biographical affidavit (.pdf format)

Applicable Law & Rules

• Texas Insurance Code art. 21.58A
• 28 TAC §§19.1701-19.1722 (Health Utilization Review)
• 28 TAC §§19.2001-19.2021 (Workers Compensation Utilization Review)
• 28 TAC §§3.8001-3.8030 (Standards for Reasonable Cost Control & Utilization Review for Chemical Dependency Treatment Centers)

URA CERTIFICATION RENEWAL

Applicable Law & Rules

• 28 TAC §19.1704 (Health Utilization Review)
• 28 TAC §19.2004 (Workers Compensation Utilization Review)

URA NAME CHANGE

• Name Change Form (.pdf format)

• URA Summary Data Collection
• Commercial Health Instructions
• Childrens Health Plan (CHIP) Instructions
• Workers' Compensation Network and Non-Network Instructions

Applicable Law & Rules

• 28 TAC §19.1716(b) (Health Utilization Review)
• 28 TAC §19.2016(b) (Workers Compensation Utilization Review)

INDEPENDENT REVIEW ORGANIZATION (IRO) FORMS

• Instructions to URA regarding notification procedures for independent review. (.pdf format)
• Notices of adverse determination and appeal denial (URA must send these forms to Enrollee/Provider)(.pdf format)
• Request from Enrollee/Provider for IRO review (This form must first be sent to URA or health plan by Enrollee/Provider) (.pdf format)

For more information contact: URAGrp@tdi.state.tx.us