Texas Department of Insurance

Workers' Compensation Resources for Health Care Providers

• Billing and Reimbursement  
• Complaints 
• Designated Doctor Resources
• Dispute Resolution
• Find a Doctor
• Helpful E-mail Addresses and Websites for Providers
• Office of the Medical Advisor
• Performance Based Oversight
• Things You Need to Know
• Training and Resources
• Treatment and Return to Work Guidelines  
• Workers' Compensation Health Care Networks
• Workers' Compensation in Texas

   Billing and Reimbursement

• eBill (Electronic Medical Billing) homepage
• Clean Claim and eBill Workers' Compensation Companion Guide 
• Fee Guidelines (Prior Medical Fee Guideline)
• Health Care Provider/Medical Forms Home Page
• CMS 1500 form information (CMS website)
• Preauthorization
  • Work Hardening and Work Conditioning Programs Exempted from Preauthorization and Concurrent Review
• Memos
  • Use of Pharmaceuticals in the Texas Workers’ Compensation System
  • National Provider Identification Number Requirement
  • 95-Day Billing Guidance for Providers
• External Resources (for more see Helpful E-mail Addresses and Websites for Providers)
  • Claim adjustment reason codes, see: Washington Publishing Company EDI Resources at  http://www.wpc-edi.com/Providers  
  • Dental, home health and some DME: see the Texas Medicaid and Healthcare Partnership website at http://www.tmhp.com/default.aspx
  • Durable medical equipment: see the Cigna Government Services website at http://www.cignagovernmentservices.com/
  • Non-DWC specific coding and billing issues: see the CMS website at http://www.cms.hhs.gov/
  • Professional Fee Schedule by Texas Region: see the Texas Medical Association website at http://www.texmed.org/Template.aspx?id=6611
  • Professional services (covers most professional services): see the TrailBlazer Health website at http://www.trailblazerhealth.com/

   Complaints 

• Complaint Resolution form
• Fast Facts: Disputes and Complaints in the Workers’ Compensation System
• Reporting Your Complaint
• TDI Complaint Resolution at (800) 372-7713 or fax (512) 490-1030  

   Designated Doctor Resources

• Designated Doctor homepage
  • DWC Form-032, Request for Designated Doctor
  • Designated Doctor / Impairment Rating Training
  • DD Publications
  • Quick Reference Guide for Designated Doctors

   Dispute Resolution

• Fast Facts: Disputes and Complaints in the Workers’ Compensation System 
• Medical Fee Dispute Resolution (contact MFDR staff at 512-804-4812) 
• Medical Necessity - For information about the Medical Dispute Resolution by Independent Review Organizations (IRO) process see the IRO web-page.
  • Fast Facts: Review of Medical Necessity Disputes by an IRO
• Participating in a Benefit Review Conference  

   Find a Doctor 

• Find a Doctor

   Office of the Medical Advisor

• Office of the Medical Advisor homepage 

   Performance Based Oversight

• 2009 Performance Based Oversight Assessment Results 
• System Monitoring & Oversight homepage

   Things You Need to Know

• TDI-DWC Contact Information
  • Customer Services  800-252-7031
  • Other Helpful Numbers
  • Central Office & Field Offices
  • Field Offices by County
• Current Division Initiatives
• Healthcare Provider FAQs
• Health Care Provider/Medical Forms Home Page
  • Commissioner Bulletin B-0052-07 - Retaining the Statement of Pharmacy Services (DWC-66)
  • Fast Facts: Medical Forms
• Memos
  • Hospital Billing Practices Review
  • TDI-DWC Clarifies Documentation Required for Payment of Medical Bills
  • Guidance for Implementation of Legislative Changes
  • Providing Health Care to Injured Employees in the Texas Workers’ Compensation System Beginning September 1, 2007
  • Reminder of March 1, 2008 Deadline for Filing for Subclaimant Status
• How to Request Public Information

   Training and Resources

• 2009 Workers' Compensation Educational Conference 
• Basic Workers’ Compensation for Medical Office Staff -  New dates for this seminar will be scheduled beginning in March 2009.  Check the events calendar for a seminar in your area.
• Designated Doctor and Impairment Rating Education
• Events & Training Calendar / Educational Session News Releases
• FastFacts for Health Care Providers
• Fee Guidelines Information
•  
• 2008 Workers' Compensation Educational Conference Resources   

   Treatment and Return to Work Guidelines (Disability Management)

• Treatment and Return to Work Guidelines 
• Disability Management homepage
• Return to Work homepage

   Workers' Compensation Health Care Networks

• WCNET homepage
• Informal Network Reporting 

   Workers' Compensation in Texas

• Fast Facts: Financial Disclosure
• About the Division of Workers' Compensation
• Texas Workers' Compensation Act and Rules
• Workers' Compensation in Texas Fact Sheet

For more information contact: