Billing

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Submit a bill
Texas law requires health care providers, with some exceptions, to submit their bills to insurance carriers electronically. Texas Mutual Insurance Company has chosen Jopari Solutions Inc. as its eBilling partner.

For more information about billing insurance carriers, employers and injured workers, see DWC Rule 133.200.

Billing tips
You can help ensure that the billing process goes smoothly by following these tips:

Use the proper DWC billing form, making sure to complete all required fields.
- CMS-1500 for all physician services (using the instructions on the DWC-67)
- UB-04 for all facility charges, including hospital, inpatient and outpatient services, and ambulatory surgical services (using the instructions on the DWC-68)
- DWC-66 for all pharmacy services (this form includes the proper instructions)
Make sure the bill is complete, per DWC Rule 133.1, before you submit it. See DWC Rule 133.210 for documentation requirements.
Submit bills within 95 days of the date of service.
Provide a valid state medical license number.
Provide valid diagnosis codes (ICD-9 codes).
Provide valid procedure codes.
Provide valid NABP and FID numbers.
Include modifiers for procedure codes when required.
Include a physical address in Box 32 for ambulance bills.
Use the required CPT codes from the current CPT code book.

Voluntary Network
In accordance with House Bill 473, Texas Mutual is implementing an informal network, also know as voluntary, workers' compensation health care network. The network applies to claims that are not part of our proprietary, Texas Department of Insurance-certified Texas Star Network^®. The informal network program is effective August 15, 2008.

We contracted with Coventry Premier Network for access to its informal preferred provider organization (PPO) network. The Coventry Premier Network includes provider contracts with Aetna, First Health and Focus. If contract discounts are applied, specific information as to the appropriate contract will appear on the provider's Explanation of Benefits.

Providers with questions concerning contracted discounts may contact Coventry Premier Network at (800) 243-2336.

Check bill status
To check the status of a claim or bill payment, click here, or call
(888) 53-CLAIM (532-5246). Be sure you have the following information:

Injured worker's social security number
Health care provider FEIN
Date of service