TDI Issues Bulletin on UR Determinations for Experimental, Investigational Services

Adverse determinations and workers’ compensation utilization review decisions based on experimental or investigational health care services are subject to UR requirements in state law, the Texas Department of Insurance said in a bulletin issued Monday. Comp carriers, health plan insurers and UR agents should review and ensure compliance with the requirements, the department said in its bulletin. Carriers and UR agents should ensure they’re using appropriate personnel, screening criteria and procedures. They should also ensure they’re issuing adverse determination notices in...