DWC Announces 2018 Insurance Carrier PBO Measures
The Texas Division of Workers’ Compensation has announced weighted measures, selection criteria and data timeframes for the 2018 Performance Based Oversight report cards for insurance carriers. The Division’s full description of carrier performance can be found here.
Insurance Carrier Selection Criteria: The insurance carriers selected for the 2018 PBO assessment are selected based on the following: • The volume of initial payment of Temporary Income Benefit transactions between January 1, 2017 and June 30, 2017 • Initial Payment of TIBs Volume of Lowest number of initial payments: 20
Weighted Measures: The Division has not changed the weighted measures from the 2016 PBO criteria. The selected insurance carriers will be assessed on the following measures for the 2018 PBO assessment:
1. Timely payment of initial Temporary Income Benefits by the insurance carrier – 40% weight
2. Timely processing of initial medical bills by the insurance carrier – 30% weight
3. Timely processing of request for reconsideration medical bills by the insurance carrier – 10% weight
4. Timely submission of Initial Payment data via Electronic Data Interchange (EDI) – 10% weight
5. Timely submission of Medical Bill Processing data via EDI – 10% weight
Data Timeframe used for 2018 Assessment: For the insurance carriers the data timeframe used to assess performance of the above measures will be: All insurance carrier measures: January 1, 2018 through June 30, 2018
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