The Texas Department of Insurance, Division of Workers’ Compensation (DWC) announced on Feb. 23 that it has adopted amendments to the Texas Administrative Code to update and enhance its data collection methods.
Provisions in the adopted rules related to the implementation of claim Electronic Data Interchange Release reporting are effective July 26, 2023. The adopted rules will be published in the March 4, 2022 edition of the Texas Register.
DWC has also adopted new and revised versions of these DWC forms and notices:
- Revised EDI-03, Claim and Medical EDI Compliance Coordinator and Trading Partner Notification. The revised form allows insurance carriers to report the name of their claim EDI compliance coordinator. This revised form is available to use immediately.
- New Plain Language Notice (PLN) 02B, Notice of First Payment of Income Benefits on an Acquired Claim (PLN-02B). The new PLN-02B allows insurance carriers to inform injured employees when a new claims administrator begins sending income benefit payments to an injured employee and align with the proposed new claim EDI reporting requirement for this claim action. The PLN-02, Notice of First Temporary Income Benefit Payment will remain the same, but DWC will renumber it as the PLN-02A.
- New PLN-10B, Notice of Lump Sum Payment of Income or Death Benefits. The new PLN requires insurance carriers to inform an injured employee or beneficiary when they send a lump sum payment and align with the proposed updated claim EDI reporting requirements. DWC will renumber the PLN-10, Notice of Reinstatement of Indemnity Income Benefits as the PLN-10A and update instructions to reflect that lump sum payments require the insurance carrier to issue the new PLN-10B.
- Revised PLN-08, Notice of Change of Amount of Indemnity Benefit Payment. The instructions for the PLN-08 are revised to reflect that lump sum payments require the insurance carrier to issue the new PLN-10B.
- Revised PLN-11, Notice of Disputed Issues and Refusal to Pay Benefits. The instructions for this PLN are revised to reflect the new requirement to report disputes of disability using the proposed updated claim EDI reporting requirements.
- Revised PLN-14, Notice of Continuing Investigation. The instructions for this PLN are revised to reflect the new requirement to report disputes of disability using the proposed claim EDI reporting requirements.
Source: Texas Department of Insurance, Division of Workers’ Compensation
Topics Texas Workers' Compensation
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