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Workers’ Compensation Network Contracting

Workers’ Compensation Network Contracting. What’s In It For Me?!. Charles Reyna IV HWCNC & QA Division Texas Department of Insurance. 3 “Os”. Opportunity Oversight Outlet.

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Workers’ Compensation Network Contracting

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  1. Workers’ Compensation Network Contracting What’s In It For Me?! Charles Reyna IV HWCNC & QA Division Texas Department of Insurance

  2. 3 “Os” • Opportunity • Oversight • Outlet

  3. Opportunity – n, pl, -ties 1: a favorable juncture of circumstances; 2: a good chance for advancement or progress. A provider has the opportunity to participate in the delivery of health care services to injured employees who are required to receive treatment for a work-related injury through a WC network.

  4. Oversight - n, 1: watchful and responsible care; 2: an inadvertent omission or error. • WC Network-Provider contracts AND Sub-contracts must include certain provisions and comply w/all applicable laws and rules • Billing by and payment to a WC Network-contracted provider must be in accordance w/§408.027, Labor Code • WC Network-Provider contracts must include a “no-retaliation” clause • WC Network-Provider contracts may not involve the transfer of risk

  5. Outlet – n, 1 a: a place or opening through which something is let out: exit, vent; b: a means of release or satisfaction for an emotion or impulse; 2: a stream flowing out of a lake or pond; 3 a: a market for a commodity b: an agency (as a store or dealer) through which a product is marketed; 4: a set of mounted and insulated electric-service terminals to which electric appliances may be connected. If you have any concerns about a WC Network’s compliance with applicable requirements, you may file a complaint with:

  6. TEXAS DEPARTMENT OF INSURANCE Health and WC Network Certification & QA 333 Guadalupe • P.O. Box 149104 Austin, Texas 78714-9104 866-554-4926 toll free • 512-322-4266 www.tdi.state.tx.us HWCN - Mail Code 103-6A• 512-490-1013 fax IRO - Mail Code 103-5A • 512-490-1011 fax WC Networks - MC 103-5B • 512-490-1028 fax

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