454-14-4081-m4-np
DECISION AND ORDER New Hampshire Insurance Company (Carrier) challenges the order granting additional reimbursement to Texas Health of Azle (Provider) for services provided to an injured worker in an emergency room. The issue in this case is whether the Provider is entitled to additional reimbursement for services billed under Current Procedural Terminology Code (CPT) 96375. […]
454-14-2499-m4
DECISION AND ORDER Plaza Specialty Hospital (Plaza) seeks additional reimbursement from Highlands Casualty Company (Highlands) for inpatient hospital services it provided to a workers’ compensation claimant from August 20, 2008, to September 26, 2008. Plaza failed to prove it was entitled to additional reimbursement. Accordingly, its request for additional reimbursement is denied. I.JURISDICTION, NOTICE, AND […]
454-11-5700-m4
DECISION AND ORDER I. INTRODUCTION This docket consolidated for hearing 23 cases (Consolidated Docket), listed on Attachment A, because they involve the same basic legal issues and evidence. Each case involves hospital outpatient services rendered by Vista Medical Center Hospital, Vista Hospital of Dallas, or Surgery Specialty Hospital of America (collectively “Vista”) between 2003 and […]
454-14-1702-m4
DECISION AND ORDER I. INTRODUCTION This case involves clinical laboratory services rendered by Texas Medical Toxicology (TMT) to an injured employee covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division)[1] conducted medical dispute resolution (MDR) and ordered Texas Mutual Insurance Company (Carrier) to make an additional reimbursement […]
454-11-2417-m4-etal
DECISION AND ORDER I. INTRODUCTION This docket consolidated for hearing 113 cases (listed on Attachments A and B) because they involve the same basic legal issues and evidence (Consolidated Docket). Each case involves hospital outpatient services rendered by Renaissance Hospitals (Renaissance)[1] between 2002 and 2007 to an injured employee covered by the Texas workers’ compensation […]
454-14-1561-m4-np
DECISION AND ORDER St. David’s Rehabilitation Oaks Hospital (Provider) requested a hearing to contest a medical fee dispute resolution order issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding a claim for $52,490.00 in medical services provided to ___ (Claimant). In its order, the Division found that Provider was not entitled […]
454-12-6138-m4
DECISION AND ORDER XL Specialty Insurance Co. (Carrier) challenges the Medical Fee Dispute Findings and Decision of the Texas Department of Insurance, Division of Worker’s Compensation (DWC), Medical Review Division (MRD), that ordered reimbursement of an additional $21,895.07 to PRIDE (Provider) for medical services provided to an injured worker (Claimant). The Administrative Law Judge (ALJ) […]
454-14-0405-m4
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) challenges the order granting additional reimbursement to Doctors Hospital at Renaissance (Provider) for services provided to an injured worker. The issue in this case is whether Provider is entitled to reimbursement for services billed under Current Procedural Terminology code (CPT) 29879. Carrier contends, based on applicable fee […]
454-13-0142-m4
DECISION AND ORDER BASED UPON STIPULATIONS Texas Mutual Insurance Company (TMIC) challenges the award of additional reimbursement to Doctors Hospital at Renaissance (DHR) for hospital outpatient services performed at DHR for an injured worker in ____ 2010. The parties have stipulated that TMIC paid the amount due DHR under the applicable fee guideline. The Administrative […]
454-13-2593-m4
DECISION AND ORDER TPCIGA for Reliance National Indemnity Company, an Impaired Carrier (Carrier), challenges the Texas Department of Insurance, Division of Workers’ Compensation (DWC) Medical Fee Dispute Resolution Findings and Decision of December 28, 2012 (Decision) requiring additional reimbursement of $6,125.75 to Garland Community Hospital (Provider). The Administrative Law Judge (ALJ) finds that Carrier has […]