The Texas Division of Workers' Compensation has adopted new general rules for medical billing and processing for voluntary and or informal networks including changes to Rule 133.2, 133.4, and 133.5.

House Bill 473 required the Division to implement rules regarding voluntary or informal networks.  Voluntary networks can exist until December 31, 2010.   Beginning in 2011, all voluntary or informal networks must become a certified workers' compensation network.

The insurance carrier, informal or voluntary network, or the insurance companies’ authorized agent must provide notice to the health care providers including: (1) informal or voluntary network contact information; (2) notice all parties were given access to the informal or voluntary networks including the start and end date of that entities access to the contracted fee arrangement; and (3) notice in written or electronic format can be provided through a website if the website contains all information and is updated at least monthly with current and correct information.  Failure to provide the required documentation or notice creates a rebuttable presumption in a division enforcement action or a medical fee dispute the medical healthcare provider did not receive the notification.

For networks that are in effect as of August 1, 2008, the insurance carrier, the insurance carrier’s agent, or the voluntary or informal network must provide notice by November 1, 2008 to all affected healthcare providers.  For contracts entered into after August 1, 2008, the initial notification must be made no later than thirty (30) days after the effective date of the contract.  All notices must be updated on a quarterly basis. (But, if notice is provided by website it must be updated monthly).

The Division disagrees with commentators who believed administrative violations were not authorized by House Bill 473.  DWC interpreted the bill and the statutory language in a manner that allows the Division to issue administrative violations to an insurance carrier for any violations made by the carrier, its agent, or the informal or voluntary network.

The informal or voluntary network must submit the information to the Division including: (1) executive contact for official correspondence; (2) toll-free number; (3) a list of insurance carriers with whom the network contracts; and (4) a list of each entity associated with the network working on behalf of the insurance carrier, including contact information for each entity.  The informal or voluntary network must submit information to the Division pursuant to its online reporting system at http://www.tdi.state.tx.us/.