DWC Sets PBO Measures, Dates for 2016

The Texas Department of Insurance, Division of Workers’ Compensation has announced the details underlying the performance measures to be applied to the insurance carrier Performance Based Oversight assessment for 2016. The PBO data time frame for the 2016 assessment will run from January 1, 2016 through June 30, 2016.

The Division will utilize the same weighted measures that were used in 2014, as described below:

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

PBO assessments are conducted by underwriting company, not by group or by TPA. Carriers and TPAs should review their internal procedures with an emphasis on compliance with these five measures beginning January 1, 2016. Should you have questions regarding this issue, please contact James Sheffield, Steve Tipton, or Bobby Stokes.