EDI FAQ of the Week
The Division of Workers’ Compensation maintains a resource page for EDI issues. Among the features on that page, the Division posts an EDI FAQ of the week. This week’s FAQ and answer:
FAQ of the week:
Q: What are the actions that trigger the responsibility to report workers’ compensation medical billing data to Texas?
A: 28 TAC §134.805(a) provides that insurance carriers shall submit medical EDI records to DWC when the insurance carrier:
(1) pays a medical bill;
(2) reduces or denies payment for a medical bill;
(3) receives a refund for a medical bill; or
(4) discovers that a medical EDI record should not have been submitted to the division and the medical EDI record had previously been accepted by the division.
In addition, reimbursement to an injured employee for health care paid in accordance with §133.270 or reimbursement to an employer for health care paid in accordance with 133.280 are also required to be reported.
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