# 28 Tex. Admin. Code § 19.2007: 28 TAC § 19.2007. URA Contact with and Receipt of Information from Health Care Providers > Texas · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2007 ## Section - **Citation:** 28 Tex. Admin. Code § 19.2007 - **Heading:** 28 TAC § 19.2007. URA Contact with and Receipt of Information from Health Care Providers - **Jurisdiction:** Texas - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Texas Administrative Code / Title 28 INSURANCE / Part 1 TEXAS DEPARTMENT OF INSURANCE / Chapter 19 LICENSING AND REGULATION OF INSURANCE PROFESSIONALS / 28 TAC § 19.2007 ## Text (a) If a URA must reimburse health care providers for providing medical information under Insurance Code §4201.207, reimbursement is limited to the reasonable costs for providing medical records relevant to the utilization review that were requested by the URA in writing. A health care provider's charge for providing medical information to a URA must comply with §134.120 of this title (relating to Reimbursement for Medical Documentation) and may not include any costs that are recouped as a part of the charge for health care. Nothing in this subsection removes the health care provider's requirement to provide information to substantiate the medical necessity of health care requested under Chapter 134 of this title (relating to Benefits--Guidelines for Medical Services, Charges, and Payments) or to submit required documentation when submitting a medical bill under Chapter 133 of this title (relating to General Medical Provisions). (b) When conducting utilization review, a URA must request all relevant and updated information and medical records to complete the review. (1) This information may include identifying information about the injured employee; the claim; the treating physician, doctor, or other health care provider; and the facilities rendering care. It may also include clinical and diagnostic testing information regarding the diagnoses of the injured employee and the medical history of the injured employee relevant to the diagnoses and the compensable injury, the injured employee's prognosis, and the plan of treatment prescribed by the provider of record, along with the provider of record's justification for the plan of treatment. The required information should be requested from the appropriate sources. (2) A URA must not routinely request copies of all medical records on injured employees reviewed. During utilization review, copies of the necessary or pertinent sections of medical records should only be required when a difficulty develops in determining whether the health care is medically necessary or appropriate or experimental or investigational in nature. (c) The URA must share among its various divisions all clinical and demographic information on individual injured employees to avoid duplicate requests for information from injured employees, physicians, doctors, and other health care providers. (d) A URA may not require as a condition of approval of a health care service, or for any other reason, the observation of a psychotherapy session or the submission or review of a mental health therapist's process or progress notes that relate to the mental health therapist's treatment of an injured employee's mental or emotional condition or disorder. This prohibition extends to requiring an oral, electronic, facsimile, or written submission or rendition of a mental health therapist's process or progress notes. This prohibition does not preclude the URA from requiring submission of: (1) an injured employee's mental health medical record summary; or (2) medical records or process or progress notes that relate to treatment of conditions or disorders other than a mental or emotional condition or disorder. ## Nearby sections - [28 Tex. Admin. Code § 19.2001 28 TAC § 19.2001. General Provisions](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2001.md) - [28 Tex. Admin. Code § 19.2002 28 TAC § 19.2002. Applicability](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2002.md) - [28 Tex. Admin. Code § 19.2003 28 TAC § 19.2003. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2003.md) - [28 Tex. Admin. Code § 19.2004 28 TAC § 19.2004. Certificate or Registration of URAs](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2004.md) - [28 Tex. Admin. Code § 19.2005 28 TAC § 19.2005. General Standards of Utilization Review](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2005.md) - [28 Tex. Admin. Code § 19.2006 28 TAC § 19.2006. Requirements and Prohibitions Relating to Personnel](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2006.md) - [28 Tex. Admin. Code § 19.2007 28 TAC § 19.2007. URA Contact with and Receipt of Information from Health Care Providers](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2007.md) - [28 Tex. Admin. Code § 19.2008 28 TAC § 19.2008. On-Site Review by a URA](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2008.md) - [28 Tex. Admin. Code § 19.2009 28 TAC § 19.2009. Notice of Determinations Made in Utilization Review](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2009.md) - [28 Tex. Admin. Code § 19.2010 28 TAC § 19.2010. Requirements Prior to Issuing Adverse Determination](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2010.md) - [28 Tex. Admin. Code § 19.2011 28 TAC § 19.2011. Written Procedures for Appeal of Adverse Determinations](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2011.md) - [28 Tex. Admin. Code § 19.2012 28 TAC § 19.2012. URA's Telephone Access and Procedures for Certain Drug Requests and Post-Stabilization Care](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2012.md) - [28 Tex. Admin. Code § 19.2013 28 TAC § 19.2013. Confidentiality](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2013.md) - [28 Tex. Admin. Code § 19.2014 28 TAC § 19.2014. Regulatory Requirements Subsequent to Certification or Registration](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2014.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2007. Check the current official text before relying on it. Not legal advice.