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Texas: Explanation of benefits gets rewrite
The Division of Workers' Compensation proposed amendments to rules regarding general medical provisions and preauthorization, concurrent utilization review, and voluntary certification of health care.
The rules clarify the division's requirements for explanations of benefits submitted in paper format. The rules extend the time period for an insurance carrier to take final action on a request for reconsideration from 21 days to 30 days and shorten the time period for a health care provider to request reconsideration from 11 months to 10 months. The rules also permit a requestor to resubmit a request for preauthorization for the same health care services if the requestor can provide objective clinical documentation to support a substantial change in the injured worker's course of treatment or other applicable clinical circumstance. Public comments are accepted until Jan. 30 and should be emailed to rulecomments@tdi.state.tx.us. Once the rules are adopted, the division plans to eliminate a form entitled "Explanation of Benefits." For more information, visit www.tdi.texas.gov/wc/rules/proposedrules/documents/pr133341211.pdf. Read more at the WorkersComp Forum homepage.
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