The Texas LHL005 form is a pivotal document for organizations aiming to operate as Utilization Review Agents (URAs) within the state, governed by the Texas Department of Insurance. This form serves a multi-fold purpose including applications for original certification, renewal, and updates or changes to existing applications. This comprehensive form requires detailed information about the applicant, including the business name, contact details, organizational category, and the type of utilization review performed. Additionally, it distinguishes between different types of URAs based on whether they manage workers' compensation health care network, non-network, or health utilization review. The submission of this form, contingent on the nature of the application, may necessitate the attachment of various fees, except for registered URAs linked to licensed health maintenance organizations or insurance companies performing utilization review for their own enrollees. The form is detailed, requiring information on primary contacts, agents for service of process in Texas, and the main contact for complaints, ensuring comprehensive accountability and regulatory compliance. Instructions accompanying the LHL005 form guide applicants through completing and submitting the form, including the requisite fees, biographical affidavits for new executives, and any material changes post-certification. This meticulous process underscores the Texas Department of Insurance’s commitment to maintaining high standards for URAs, ensuring that entities engaged in utilization review adhere to state statutes and regulations, fostering transparency, and protecting the interests of all stakeholders in the health and workers' compensation arenas.
| Question | Answer |
|---|---|
| Form Name | Texas Form Lhl005 |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | lhl005uraapp texas lhl005 form |
