Texas Regulations 10.101
From Wcc
§ 10.101 General Standards for Utilization Review and Retrospective Review.
| (a) Screening criteria used for utilization review and retrospective review related to a workers� compensation health care network must be consistent with the network�s treatment guidelines, return-to-work guidelines, and individual treatment protocols.
(b) The carrier�s utilization review program and retrospective review program must include a process for a treating doctor or specialist to request approval from the network for deviation from the treatment guidelines, return-to-work guidelines, and individual treatment protocols where required by the particular circumstances of an employee's injury. |
