129.3
(a) The insurance carrier (carrier) shall pay an injured employee (employee) the temporary income benefits (TIBs) the employee is entitled to in accordance with this chapter. (b) The carrier shall determine whether the employee earns less than $8.50 per hour for a workers’ compensation claim with a date of injury before September 1, 2015, or […]
129.11
(a) Upon the request of an injured employee, the insurance carrier and an injured employee entitled to temporary income benefits (TIBs) may agree to change the frequency of TIBs payments from the standard weekly period to a monthly period. The agreement to change the payment frequency must be in writing and is only required to […]
110.108
(a) Each employer covered by workers’ compensation insurance, including state and political subdivision employers, which employ emergency medical service employees, paramedics, fire fighters, law enforcement officers or correctional officers must post the notice contained in subsection (d) of this section, in its workplace to inform employees about Health and Safety Code requirements which may affect […]
110.110
(a) The following words and terms, when used in this rule, shall have the following meanings, unless the context clearly indicates otherwise. Terms not defined in this rule shall have the meaning defined in the Texas Labor Code, if so defined. (1) Certificate of coverage (certificate)–A copy of a certificate of insurance, a certificate of […]
134.802
(a) The following words and terms, when used in this subchapter, shall have the following meaning, unless the context clearly indicates otherwise: (1) Application Acknowledgment Code–A code used to identify the accepted or rejected status of the transaction being acknowledged. (2) Claim Adjustment Reason Code (CARC)–A code that is used on a medical EDI record […]
134.803
(a) Except as provided in this subchapter, the commissioner adopts by reference the IAIABC EDI Implementation Guide for Medical Bill Payment Records, Release 1.0, dated July 4, 2002 (IAIABC Guide) published by the IAIABC. (b) The commissioner adopts by reference the Texas EDI Medical Data Element Requirement Table, Version 2.0, dated September 2015, the Texas […]
134.804
(a) Insurance carriers shall submit an ’00’ original medical EDI record for each action (initial processing, request for reconsideration or appeal, or subsequent orders) taken on an individual medical bill. Original medical EDI records shall be reported within 30 days after the date of the action. Each iteration of an ’00’ original medical EDI record […]
134.805
(a) Insurance carriers shall submit medical EDI records when the insurance carrier: (1) pays a medical bill; (2) reduces or denies payment for a medical bill, including duplicate bills; (3) receives a refund for a medical bill; (4) discovers that a medical EDI record should not have been submitted to the division and the medical […]
134.807
(a) A medical EDI transmission shall not exceed a file size of 1.5 megabytes. A transaction set shall not contain more than 100 medical EDI records in a claimant hierarchical loop. (b) Insurance carriers shall submit medical EDI transactions using Secure File Transfer Protocol (SFTP). All alphabetic characters used in the SFTP file name must […]
134.808
(a) Insurance carriers may submit medical EDI records directly to the division or may contract with an external trading partner to submit the records on the insurance carrier’s behalf. (b) Each insurance carrier, including those using external trading partners, must designate one individual to the division as the EDI Compliance Coordinator and provide the individual’s […]