276.11
Upon written request, a health care provider shall provide the Office of Injured Employee Counsel (OIEC) medical documentation regarding an injured employee within five (5) business days from the date posted on the request at no cost to OIEC. A health care provider’s reimbursement from an insurance carrier for costs of documentation provided to OIEC […]
134.1
<For validity of this section, see PHI Air Medical, LLC v. Texas Mutual Insurance Company, 549 S.W.3d 804 (Tex. App. 2018).> <For validity of this section, see Air EVAC EMS, Incorporate v. Sullivan, 8 F.4th 346 (5th Cir. 2021).> (a) “Maximum allowable reimbursement” (MAR), when used in this chapter, is defined as the maximum amount […]
134.2
(a) When required by Division rule, an incentive payment shall be added to the maximum allowable reimbursement (MAR) for services performed in a designated workers’ compensation underserved area. (b) The following list of ZIP Codes comprise the Division designated workers’ compensation underserved areas: 75134, 75135, 75161, 75181, 75212, 75410, 75558, 75603, 75630, 75650, 75653, 75654, […]
134.203
<For validity of this section, see PHI Air Medical, LLC v. Texas Mutual Insurance Company, 549 S.W.3d 804 (Tex. App. 2018).> <For validity of this section, see Air EVAC EMS, Incorporate v. Sullivan, 8 F.4th 346 (5th Cir. 2021).> (a) Applicability of this rule is as follows: (1) This section applies to professional medical services […]
134.403
(a) Applicability of this section is as follows. (1) This section applies to medical services provided in an outpatient acute care hospital on or after March 1, 2008. (2) This section does not apply to: (A) professional medical services billed by a provider not employed by the hospital, except for a surgical implant provider as […]
134.404
(a) Applicability of this section is as follows. (1) This section applies to medical services provided in an inpatient acute care hospital with an admission date on or after March 1, 2008. (2) For admission dates prior to March 1, 2008, the law and Division of Workers’ Compensation (Division) rules in effect for those dates […]
180.19
(a) The purpose of this section is to develop incentives and emphasize performance-based oversight to regulatory outcomes. Regulatory outcomes are assessed for the following key regulatory goals: (1) provide timely and accurate income and medical benefits; (2) increase timely and accurate communications among system participants; (3) encourage safe and timely return of injured employees to […]
137.1
(a) Disability management is a process designed to optimize health care and return to work outcomes for injured employees to avoid delayed recovery in the Texas Workers’ Compensation System. (b) This chapter is designed to provide disability management tools, such as treatment and return to work guidelines, treatment protocols, treatment planning, and case management to […]
137.10
(a) Insurance carriers, health care providers, and employers shall use the disability duration values in the current edition of The Medical Disability Advisor, Workplace Guidelines for Disability Duration, excluding all sections and tables relating to rehabilitation, (MDA), published by the Reed Group, Ltd. (Division return to work guidelines), as guidelines for the evaluation of expected […]
137.100
(a) Health care providers shall provide treatment in accordance with the current edition of the Official Disability Guidelines-Treatment in Workers’ Comp, excluding the return to work pathways, (ODG), published by Work Loss Data Institute (Division treatment guidelines), unless the treatment(s) or service(s) require(s) preauthorization in accordance with §134.600 of this title (relating to Preauthorization, Concurrent […]