# 28 Tex. Admin. Code § 19.2010: 28 TAC § 19.2010. Requirements Prior to Issuing Adverse Determination

> Texas · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2010

## Section

- **Citation:** 28 Tex. Admin. Code § 19.2010
- **Heading:** 28 TAC § 19.2010. Requirements Prior to Issuing Adverse Determination
- **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 § 19.2010

## Text

In any instance in which a URA is questioning the medical necessity
 or appropriateness of the health care services prior to issuance of
 an adverse determination, the URA must afford the provider of record
 a reasonable opportunity to discuss the plan of treatment for the
 injured employee with a physician, dentist, or chiropractor. If the
 health care services in question are dental services, then a dentist
 may conduct the discussion if the services in question are within
 the scope of the dentist's license to practice dentistry. If the health
 care services in question are chiropractic services, then a chiropractor
 may conduct the discussion if the services in question are within
 the scope of the chiropractor's license to practice chiropractic.
 The discussion must include, at a minimum, the clinical basis for
 the URA's decision and a description of documentation or evidence,
 if any, that can be submitted by the provider of record that, on appeal,
 might lead to a different utilization review decision.
(1) The URA must provide the URA's telephone number
 so the provider of record may contact the URA to discuss the pending
 adverse determination.
(2) The URA must maintain, and submit to TDI or TDI-DWC
 on request, documentation that details the discussion opportunity
 provided to the provider of record, including the date and time the
 URA offered the opportunity to discuss the adverse determination,
 the date and time that the discussion, if any, took place, and the
 discussion outcome.

## 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)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_2010. Check the current official text before relying on it. Not legal advice.