Texas Mutual Insurance Company - Providers of Workers' Comp Insurance

Billing

Electronic billing

Electronic billing provider:

Jopari Solutions, payer ID - 22945 (Phone: (866) 269-0554)

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, a California-based supplier of eBilling and payment solutions for the insurance industry, to manage its eBilling system. Under the agreement, Jopari serves as a gateway between providers and Texas Mutual Insurance Company for electronic remittance advice and the submission of electronic bills and attachments.

Texas Mutual's electronic billing system complies with workers' compensation electronic billing requirements mandated by the Texas Department of Insurance. It also responds to providers' requests for a streamlined, paperless billing process.

Rules adopted by the Texas Department of Insurance, Division of Workers' Compensation required health care providers to begin submitting their bills electronically as of January 1, 2008. If a provider has less than 10 employees, and workers' comp represents less than 10 percent of their business, they are exempt from these requirements.

For more information about electronic billing, or to register for Texas Mutual electronic billing services, call Jopari at (866) 269-0554 or visit www.jopari.com

Billing guidelines

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 and ambulatory surgical services (using the instructions on the DWC-67)
    • UB-04 for all facility charges, including hospital, inpatient and outpatient services, and home health 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.

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

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