| Summer 2010
Reminders
PPOs to be eliminated
House Bill 473 will eliminate voluntary workers’ compensation health care networks, also known as PPOs and fee for service arrangements, effective January 1, 2011. Carriers will no longer take provider billing discounts unless the injured worker and his or her claim are in a certified network.
Network announces new medical director
The Texas Star Network® has hired V. Jane Derebery, M.D., FACOEM as its new medical director.
Dr. Derebery is board certified in occupational medicine-preventive medicine, and she is a Fellow of the American College of Occupational and Environmental Medicine.
In addition to treating patients and consulting in the field of occupational medicine, Dr. Derebery serves on the executive council of the Medical Quality Review Panel of the Texas Department of Insurance, Division of Workers’ Compensation.
Want to file a network grievance?
The Texas Star Network® complaint/grievance procedure is available to any participating provider, employer, employee or employee’s authorized representative. Networks are outside the Texas Department of Insurance Medical Dispute Resolution (MDR) department’s jurisdiction, so the MDR is not an appropriate venue for filing network complaints.
If you want to file a complaint against the Texas Star Network®, complete the complaint form attached to the “Texas Provider Manual” at www.coventrywcs.com/provider-services/texas/index.htm.
A complaint is defined as any dissatisfaction expressed orally or in writing by a complainant to a network regarding any aspect of the network’s operation, including dissatisfaction related to medical fee disputes and the network’s administration, as well as the manner in which service is provided.
Contract questions?
Texas Mutual does not have access to provider contracts with Coventry, First Health, Focus or Beechstreet. If you have questions regarding your contract reimbursement or other specific contract-related questions, please contact Coventry’s workers’ compensation client services department at (800) 873-0055.
Get the current network doctor list before you make referrals
Providers who participate in Texas Mutual’s workers’ compensation health care network should visit texasmutual.com/hcn/provdir.shtm for the current network provider directory before making referrals. We continuously update our provider directory. The changes are part of our ongoing efforts to improve the quality of care for injured workers.
COMP AT WORK - SUMMER 2010
Degenerative Disc Disease: Is It Work-Related?
Get Paid Fast
The Doctor is In: Ralph Whemer, M.D.
State Increases Medical Fee Guidelines
Reminders