Website SurveySystem Monitoring and Oversight
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System Monitoring and Oversight consist of three different program areas which encourage fair treatment of system participants and the prompt delivery of benefits payments.
Performance Based Oversight Regulatory System (PBO) and Monitoring & AnalysisPerformance Based Oversight (PBO) monitors system participants’ compliance with the Texas Labor Code and Rules. PBO objectives are achieved through monitoring electronic and paper data, complaint handling, entity audits, and enforcement actions. PBO encourages and rewards excellence and continuous improvement; fosters improved and timely communications; establishes performance objectives, measures and expectations and focuses on results rather than prescriptive requirements. Monitoring and Analysis (M&A) monitors complaints, disputes, the quality and quantity of system participants’ data submissions. M&A’s objectives are achieved through monitoring of electronic data submitted to the Texas Department of Insurance, Division of Workers’ Compensation. TDI-DWC initiated additional audits of reporting medical billing and payment data for certain insurance carriers. Quarterly reports on medical billing and payment data should be provided using the MS Excel reporting template provided below. Medical Bill Quarterly Report Template - as of 3/20/2009, NEW Template containing clarification of requested information Carrier Quarterly Compliance Meetings
Complaint Resolution
Complaint Resolution seeks to encourage communications and assists Texas workers’ compensation system participants in resolving complaints. In this process, the staff examines complaints for compliance with the Texas Labor Code and DWC Rules and makes referrals to the Audit and Investigation section of System Monitoring and Oversight when appropriate. The complaint resolution process routinely results in additional claims payments to system participants.
Audits & Investigations
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