166.5
(a) Inspections. The division may conduct inspections to determine the adequacy of an insurance company’s accident prevention services. (1) Affiliated companies of an insurer may be inspected together if the same facilities, programs, and personnel are used by each of the companies. (2) At least 90 days before an inspection, the division must notify the […]
133.10
(a) Health care providers, including those providing services for a certified workers’ compensation health care network as defined in Insurance Code Chapter 1305 or to political subdivisions with contractual relationships under Labor Code §504.053(b)(2), must submit medical bills for payment in an electronic format in accordance with 133.500 and 133.501 of this title (relating to […]
133.20
(a) The health care provider must submit all medical bills to the insurance carrier except when billing the employer in accordance with subsection (j) of this section. (b) Except as provided in Labor Code §408.0272(b), (c), or (d), a health care provider must not submit a medical bill later than the 95th day after the […]
133.200
(a) On receipt of medical bills submitted in accordance with 133.10 of this chapter (relating to Required Billing Forms/Formats), an insurance carrier must evaluate each medical bill for completeness as defined in 133.2 of this chapter (relating to Definitions). (1) Insurance carriers must not return medical bills that are complete, unless the bill is a […]
133.502
(a) In addition to the data requirements and standards adopted under §133.500(a) of this title (relating to Electronic Formats for Electronic Medical Bill Processing), all professional, institutional or hospital, and dental electronic medical bills submitted before January 1, 2012, must contain: (1) the telephone number of the submitter; (2) the workers’ compensation claim number assigned […]
134.209
(a) Sections 134.209, 134.210, 134.215, 134.220, 134.225, 134.230, 134.235, 134.239, 134.240, 134.250, and 134.260 of this title apply to workers’ compensation specific codes, services, and programs provided in the Texas workers’ compensation system, other than: (1) professional medical services described in 134.203 of this title; (2) prescription drugs or medicine; (3) dental services; (4) the […]
134.210
(a) Specific provisions contained in the Labor Code or division rules, including this chapter, take precedence over any conflicting provision adopted or used by the Centers for Medicare and Medicaid Services (CMS) in administering the Medicare program. Independent review organization decisions on medical necessity made in accordance with Labor Code §413.031 and 133.308 of this […]
134.235
(a) Required medical examination doctors (RME doctors) must perform examinations in accordance with Labor Code §§408.004, 408.0041, 408.0043, and 408.0045 and division rules. (b) Each examination and its individual billable components will be billed and reimbursed separately. (c) When conducting an insurance carrier-requested examination to determine impairment or attainment of maximum medical improvement (MMI), the […]
134.239
Work status reports described by 129.5 of this title may not be billed or reimbursed separately when completed as a component of an ordered examination. The provisions of this 134.239 adopted to be effective June 1, 2024, 49 TexReg 1489.
134.240
(a) Designated doctors must perform examinations in accordance with Labor Code §§408.004, 408.0041, and 408.151 and division rules. (b) The designated doctor must bill, and the insurance carrier must reimburse, for a missed appointment when the injured employee does not attend a properly scheduled or rescheduled examination under 28 TAC §127.5(h) – (j). (1) The […]