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Texas
House Bill 7 was enacted to reform a workers’ compensation system that has experienced double-digit cost increases at the same time it has seen injury decreases. Like most sweeping legislation, the bill has numerous requirements and provisions, but its "bottom line" is straightforward: employers choose a network of medical providers experienced in treating occupational injuries, and injured employees choose from those providers for treatment. Coventry Workers’ Comp Services offers a Texas Health Care Network options to help meet these regulatory requirements.
Texas Fee for Service Program Available to Non-Subscribers
In accordance with Texas House Bill 473, all voluntary and informal networks (Fee for Service Programs) in Texas must be certified workers’ compensation networks as of January 1, 2011. The Texas Department of Insurance, Division of Workers' Compensation has determined that voluntary and informal networks (Fee for Service Programs) will continue to be available to Texas Non-Subscribers after January 1, 2011. The requirements of Texas Labor Code 413.011 do not apply to Non-Subscribers and Non-Subscribers are not subject to regulation by the Texas Department of Insurance, Division of Workers' Compensation rules. Coventry’s Texas Fee for Service Program will be available to Non-Subscribers only on and after January 1, 2011.
Texas Closed Pharmacy Resources
The Division of Workers’ Compensation has created a pharmacy resource web page providing information about the Texas closed pharmacy formulary, pharmacy fee guideline and other related pharmacy rules. The Texas closed pharmacy formulary is applicable to injuries occurring on or after September 1, 2011. http://www.tdi.state.tx.us/wc/pharmacy/index.html
The links to resources and documents below offer information for providers relative to the Texas reforms.
- TDI Memo Pharmacy Closed Formulary
- Texas Workers' Compensation System adopts Pharmacy Closed Formulary. Memo date August 1, 2011
- TDI Memo Paper and Electronic Medical Billing Requirements
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Paper and Electronic Medical Billing Requirements for Workers' Compensation Claims. Memo date August 1, 2011
- TDI to Offer Workers' Comp Training for Doctors, Designated Doctors and Medical Office Managers
- This Workers' Comp Compliance Training will be offered Thursday, May 5, 2011 and Thursday, August 4, 2011
Preauthorization Requirements
- Coventry HCN Preauthorization Requirements
- Click here for a list of the preauthorization requirements for the Coventry Workers' Comp Network HCN
- First Health HCN Preauthorization Requirements
- Click here for a copy of the preauthorization requirements for the First Health HCN
- Texas Star Network Preauthorization Requirements
- Click here for a copy of the preauthorization requirements for the Texas Star Network.
- Zenith Preauthorization Requirements
- Click here for a the list of Zenith Health Care Network Preauthorization Requirements
Client-Specific Information
- Texas Star Network (Texas Mutual Insurance)
- Liberty Mutual Health Care Network
- First Health / Constitution State Services LLC HCN
- First Health / Travelers HCN
- First Health / AIGCS TX HCN
- Zenith Heath Care Network
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Click here for additional information on client's accessing a Coventry HCN option
HCN Provider Manuals
- Download the Coventry Workers' Comp Services Texas HCN Provider Manual
- Texas Star Provider Manual
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Download a copy of the Texas Star Network provider manual
- First Health TX HCN Provider Manual
- Click here for a copy of the First Health TX HCN Provider Manual
Web Resources
- Texas Department of Insurance - Workers' Compensation Division
- TDI Medical Fee Guidelines Training Module
- Texas HB7 Provider Provisions
- The Medical Disability Advisor by Dr. Presley Reed - Reed Group
- Official Disability Guidelines
- American Academy of Disability Evaluating Physicians
- American College of Occupational and Environmental Medicine
- European Guidelines for the Management of Chronic Low Back Pain
- Texas Insurance Code
- Read chapter 1305 on the Workers' Compensation Health Care Network Act