Designated Doctors to be Audited
DWC has announced a plan-based audit of Designated Doctors (DDs) to ensure that any additional testing or referrals ordered by DDs are medically necessary, evidence-based, reasonable, and properly documented. The audit is authorized under Texas Labor Code Sections 408.0041, 408.021, and 413.002, and 28 Texas Administrative Code Sections 127.10, 127.200, 127.220, and 130.1. It will be conducted under the Medical Quality Review Process overseen by the MQRP and the DWC Medical Advisor.
The audit will review how DDs document referrals and testing in their narrative reports, including the identity of the provider, the type and date of the test or referral, the reason it was needed, and how the results were incorporated into the DD’s opinion. The review also aims to determine whether DDs select appropriate providers and adhere to evidence-based medicine.
The audit applies to examinations conducted between June 1, 2024, and May 31, 2025. It will focus on DDs with the highest number of referrals or diagnostic tests during that period. No more than ten DDs will be reviewed, and cases will be selected at random from within each DD’s examined population. The Medical Quality Review Panel (MQRP) will assess whether each referral or test was medically necessary, reasonable, evidence-based, and properly documented.
Certain cases are excluded from review, including those involving DDs with no referrals or diagnostic testing, out-of-state DDs, referrals outside the scope of DD reporting requirements, cases pending dispute resolution, and providers with less than 30 percent referral rates.
More information about the audit can be found at:
www.tdi.texas.gov/wc/hcprovider/documents/drddaudit1025.pdf
Carriers should anticipate potential requests for supporting documentation related to DD examinations. If FOL can assist in any way, please reach out to Heather Terrones at hta@fol.com.
Input by Carriers and Deadline
DWC is seeking input for this audit. Please email your suggestions for this proposed Designated Doctor Plan-Based Audit to OMA@tdi.texas.gov. The deadline to email your suggestions is 5 p.m., Central time, on October 20, 2025. You can also contact Jennifer Self with DWC at Jennifer.Self@tdi.texas.gov or 512-804-4805.
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