124.2
(a) An insurance carrier must notify the division and the claimant of actions taken on or events occurring in a claim as required by this title. (b) The insurance carrier must electronically file, as that term is used in §102.5(e) of this title (concerning General Rules for Written Communications to and from the Division) with […]
124.100
(a) This subchapter applies to any claim transactions required to be reported to the division under 124.105 on or after July 26, 2023. (b) This subchapter applies to all insurance carriers as defined in Labor Code §401.011(27). All insurance carriers are required to report information prescribed by the commissioner under Labor Code §§401.024, 402.082, 411.012, […]
124.101
The purpose of this subchapter is to prescribe the reporting requirements for information and data submitted to the division and adopt by reference the implementation guide and specifications necessary for successful EDI transaction processing. The reporting of information and data is necessary to maintain information on every compensable injury; maintain a repository for statistical information […]
124.102
The following words and terms when used in this subchapter will have the following meanings, 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 EDI record–The accurate data associated with a single claim reported in a claim EDI […]
124.103
(a) Except as provided in this subchapter, the commissioner adopts by reference the IAIABC EDI Implementation Guide for Claims, Release 3.1.4, dated January 1, 2021, published by the IAIABC. (b) The commissioner adopts by reference the: (1) Texas Claim EDI Release 3.1.4 Implementation Guide, Version 1.0; (2) Texas Claim EDI Release 3.1.4 Element Requirement Table, […]
124.104
(a) Insurance carriers must submit timely and accurate claim EDI records to the division. For the purpose of this section, a claim EDI record is considered accurately submitted when the record: (1) receives an accepted application acknowledgment code; (2) contains accurate claim EDI data, which may be obtained from all sources, including the report of […]
124.105
(a) Insurance carriers must submit claim EDI records when the insurance carrier: (1) takes action on or events occur in a claim as described in 124.2 of this title (concerning Insurance Carrier Notification Requirements); (2) corrects division-identified errors in a previously accepted electronic record as provided in §124.104(b) of this title (concerning Reporting Requirements); (3) […]
124.106
Insurance carriers must not report claim EDI records for: (1) claims where the jurisdiction state is not Texas; (2) claims that do not meet the requirements of §124.2(b); (3) claims involving benefits payable under federal workers’ compensation laws; and (4) claims with dates of injury before January 1, 1991. The provisions of this 124.106 adopted […]
124.107
(a) Insurance carriers must submit claim EDI transactions according to the: (1) IAIABC EDI Implementation Guide for Claims, Release 3.1.4; (2) Texas Claim EDI Release 3.1.4 Implementation Guide, Version 1.0; (3) Texas Claim EDI Release 3.1.4 Element Requirement Table, Version 1.0; (4) Texas Claim EDI Release 3.1.4 Edit Matrix, Version 1.0, dated June 30, 2023; […]
124.108
(a) Insurance carriers may submit claim EDI records directly to the division or 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 person to the division as the EDI compliance coordinator and provide the person’s name, […]