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Understanding Workers' Compensation Network Contracting: Opportunities and Oversight in Texas

This guide delves into the intricacies of Workers’ Compensation (WC) network contracting in Texas, highlighting the opportunities available for healthcare providers to deliver services to injured employees. It outlines essential oversight mechanisms, including compliance with applicable laws and regulatory standards. Providers must understand crucial contract provisions such as billing practices, the "no-retaliation" clause, and risk management stipulations. Additionally, guidance is provided on filing complaints if there are compliance concerns with WC networks through the Texas Department of Insurance.

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Understanding Workers' Compensation Network Contracting: Opportunities and Oversight in Texas

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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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