- Read applicable laws and rules.
- Read all instructions on the application.
- Submit complete application Do not leave blanks.
- Complete pages one and two.
- Read the required application exhibits on pages three and four of the application under “Original Application Only – Required Application Exhibits.”
- Submit the required application exhibits. Do not submit substitute documents.
- Submit all required application exhibits. You are responsible for functions you delegate to other entities or individuals.
- We do not refund original application fees.
- Texas Insurance Code Sections 4201.151, 4201.152, 4201.453, and 4201.454 require a Texas licensed physician or applicable specialty for specialty URAs. Do not submit the application without a Texas licensed physician or licensed in the applicable URA specialty.
- Additional instruction for Exhibit 1, Attachment C and Exhibit 3: submit required template letters and policies and procedures. The remaining exhibits require policies and procedures. See sample initial adverse determination template letters.
- Additional instruction for Exhibit 6: requires a biographical affidavit and fingerprint receipts for each executive, officer, and director in Exhibit 5
- Biographical affidavits must reference the applicant company. They cannot reference affiliated companies or any other company name.
- Fingerprint receipts must include the unique identification.
- Do not submit fingerprint cards or fingerprint impressions.