Workers' Compensation Advocacy

Latest News | Advocacy In Action | Sample Letters | FAQs Regarding HB7 and Workers' Compensation Reform | Resources  

 Latest News

Closed Formulary, Part Two: Workers' Comp to Require Preauthorization for "Legacies"

Legislation aiming to reduce overuse of pain medications and other addictive and expensive drugs within the workers' compensation program appears to be achieving that goal through stepped implementation of a closed formulary. With phase two of the process set to take effect this September, leaders at TMA and the Texas Department of Insurance Division of Workers' Compensation (DWC) say physicians should prepare now for what could be the more challenging part of the transition. Read More. (Texas Medicine - February 2013) 

Workers' Comp Has New Forms

Starting March 1, Designated Doctors in the Workers' Compensation program must begin using the new DWC Form-069 and DWC Form-073, and fax them to the Texas Department of Insurance Division of Workers' Compensation (TDI-DWC) at (512) 490-1047. (Action, March 1, 2011) 

Current Information

• Closed Formulary for Workers' Compensation Patients Announce (August 2011)
•  Workers' Comp Has New Forms (Action, March 1, 2011)
• Dr. Patrick Joins Workers' Comp (Action, July 15, 2010)
• Workers' Comp Grades Physicians (Action, July 1, 2010)
• TDI Wants Medical Reviewers (Action, June 15, 2010)

TMA's Workers' Compensation Advocacy in Action

• Provider Resources (TDI) 
• Workers' Compensation Fee Schedule By Region
• Workers' Comp Worth It? State Hopes Higher Fees Will Bring Doctors Back - (Texas Medicine - February 2008) 
• Disability Management for Injured Texas Workers
• Disability Management for Injured Workers (PDF)
• Carrier Phone Numbers for Determining Network Status of Injured Employees (PDF )  
• Cookbook Comp? Physicians Skeptical About Workers' Comp Guidelines   (Texas Medicine - May 2007)  
• History of the Workers' Compensation System in Texas
• Workers' Compensation Managed Care Networks Certified by the Texas Department of Insurance
• Workers' Compensation Commissioner Bulletins
• Termination of the Physician-Patient Relationship

Designated Doctor Services

• Billing and Reimbursement for Designated Doctor Services (FastFacts, TDI: Division of Workers' Compensation)

FAQs: Recent Workers' Compensation Reform From Texas Department of Insurance (TDI): Division of Workers' Compensation

•  FAQs Regarding Recent Workers' Compensation Reforms: Employees    
•  FAQs Regarding Recent Workers' Compensation Reforms: Employers    
•  FAQs Regarding Recent Workers' Compensation Reforms: Providers  

Sample Letters to Carriers

•  Reply to Carrier Request for More Information on an Incomplete Claim or More Documentation for a Retrospective Review
  View HTML version  
•  Claims in Process Over 45 Days
  View HTML version  
•  Request for Reconsideration
  View HTML version  

Additional Articles

• Division Introduces Comp Connection for Health Care Providers    
• Changes to Conversion Factors for Workers' Compensation Medical Fee Guidelines   
• Disputes and Complaints In the Workers' Compensation System (PDF) (FAST FACTS, TDI)  FAST FACTS (TDI) 
• Improper Denials Based on Lack of Documentation (PDF) 
• Electronic Medical Bill Data Exchange (eBilling) Implementation
• 2008 Medical Fee Guidelines (PDF)