DWC Proposes New Form: Claims Administration Contact Information
The Division of Workers’ Compensation is accepting public comment on a proposed new form: DWC Form-121, Claim Administration Contact Information. The form is designed to assist the agency in verifying coverage status, as well as several other things. Rule 124.2(r)(1) requires insurance carriers to provide contact information for:
• coverage verification (policy issuance and effective dates of policy);
• claims adjustment;
• medical billing;
• pharmacy billing (if different from medical billing); and
• preauthorization.
Rule 124.2 requires the insurance carrier to update the contact information on the web URL or file this form within 10 working days after change is made. The proposed form is supposed to facilitate that obligation.
Upon receipt of a completed form, DWC will update the claim administration contact information for the insurance carrier in TXCOMP, DWC’s automated system where the public can find the information. See the TDI website and select the “TXCOMP” link and choose “Locate Insurance Carrier.” After selecting an insurance carrier, click “View Claim Administration Contact.”
You may submit written comments on the form to RuleComments@tdi.texas.gov, or mail your comments to:
Cynthia Guillen
Legal Services, MS – 4D
Texas Department of Insurance, Division of Workers’ Compensation
7551 Metro Center Drive, Suite 100
Austin, Texas 78744-1645
The deadline to submit comments is 5 p.m., Central time, Thursday, February 27, 2020.
If you have questions concerning the proposed form, please contact Steve Tipton, James Sheffield, or Bobby Stokes.
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