Just for Health Care Providers

We're here to help you succeed. Find out about our health care network, pharmacy benefits, billing, forms and contact information.

Thank you for being
our return-to-work partner

The goal of workers' comp is for injured workers to return to a productive life. You play an important role in delivering the care needed to make that possible.

As your office provides care, follow these four steps:

Treat emergencies immediately or prepare to ask a few discovery questions if the situation is not urgent. Find out if the injury is work-related by asking:

  • How did the injury occur?
  • Where were you at the time of injury?

If the patient indicates that it was work related, ask if their employer has workers’ compensation coverage or use the Texas Department of Insurance coverage verification tool.

While it's up to insurance carriers to determine if claims are work-related, proceed with caring for the injured worker as a workers’ compensation patient as long as the patient indicates the injury happened at work and the employer has workers’ compensation coverage.

Many of our policyholders choose to participate in the WorkWell, TX network - Texas Mutual’s own health care network. If the patient’s employer is covered by Texas Mutual, call us at (888) 532-5246 or contact the employer to determine if they participate in the network.

Your role is to provide appropriate return-to-work focused care for injured employees. Some treatment requires pre-authorization, which you can read about below or discuss with us by calling (888) 532-5246.

If an injured employee's employer is covered by Texas Mutual, they can get their first prescription filled even if their employer hasn't filed a claim yet. Provide the injured employee with a First Fill form to use at a participating Optum pharmacy.

Learn more about preauthorization

Texas law requires health care providers to submit their bills to insurance carriers electronically unless they have fewer than 10 employees and workers’ compensation represents less than 10% of their business.

Bills for Texas Mutual should be submitted to Jopari Solutions (payer ID: 22945). For more information, contact Jopari Solutions at (866) 269-0554.

Carriers have 45 days to review and process your complete bill. After 30 days, you can check on the status of your Texas Mutual bill online or by calling (888) 532-5246.

Learn more about provider billing

The Texas Department of Insurance, Division of Workers' Compensation created DWC Form-73 to help health care providers communicate injured workers' restrictions and physical abilities to employers and insurance carriers.

This helps ensure that appropriate return-to-work programs are implemented. The form also helps the insurance carrier investigate and process the claim.

The DWC Form-73 is required:

  • After your initial examination
  • If the patient's work status changes
  • If there is a substantial change in the patient's work restrictions
  • At the insurance carrier's request (not more than once every two weeks)

DWC rules allow you to charge up to $15.00 each time you complete DWC Form-73. For more information on Form DWC-73 filing and reimbursement requirements, see Rule 129.5.

Need to request preauthorization?

  1. Fill out our Preauth request form
  2. Attach medical documentation
  3. Email to preauth@texasmutual.com

See preauth requirements

healthcare providers

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Health care network

In the WorkWell, TX health care network, we partner with high-quality, recovery-focused providers who care as much about the success of workers’ comp patients as we do. 

For resources or questions pertaining to network claims filed prior to January 1, 2018, call (888) 252-5075. 

Nominate a provider

If you know an exceptional provider who would make a good addition to the WorkWell, TX network, submit a nomination. For instructions see How to Nominate a Network Provider. The review process may take up to 30 days. 

Network provider reviews

Texas Mutual conducts reviews of network provider care. This review is subject to the notice provision of Texas Department of Insurance Rule 10.42(d)(28 TAC §10.42). If you are a network provider, this notice applies to you.

Pharmacy benefits

We partner with Optum to help injured workers get the prescriptions they need for compensable on-the-job injuries. If you need assistance from Optum, call (888) 220-2805.

If you prescribe medication for the treatment of injured workers, be familiar with the Texas Department of Insurance pharmacy regulations

Our First Fill program allows injured workers to receive a seven-day supply of their medication before their employer files a claim. 

Billing

Texas law requires most health care providers to submit their bills to insurance carriers electronically. Bills for Texas Mutual should be submitted to Jopari Solutions (payer ID: 22945). For more information, contact Jopari Solutions at (866) 269-0554.

Texas Mutual reviews bills to ensure that they were submitted timely and accurately, and that treatment and services were necessary and related to the compensable injury. After we take final action on your bill, we will generate an explanation of benefits. 

Provider billing FAQ

  1. 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)

  2. Submit bills within 95 days of the date of service. Make sure the bill is complete, per DWC Rule 133.1, before you submit it. See DWC Rule 133.210 for documentation requirements.
  3. Provide a valid state medical license number.
  4. Provide valid diagnosis codes (ICD-9 codes), procedure codes, and included modifiers for procedure codes when required.
  5. Provide valid NABP and FID numbers.
  6. Include a physical address in Box 32 for ambulance bills.
  7. Use the required CPT codes from the current CPT code book.

Contacts for quick reference

Claims and billing

  • Phone: (888) 532-5246
  • Fax: (512) 224-3889
  • Mailing address: PO Box 12029, Austin, Texas 78711-2029
  • Electronic billing partner: Jopari Solutions (Payer ID: 22945) - (866) 269-0554

Network administration

  • Phone: (844) 867-2338
  • Fax: (512) 224-8823
  • Email: wwtxadmin@texasmutual.com
  • Provider line and claim information: (888) 532-5246

Preauthorization

  • In-network phone: (888) 252-5075 
  • Out-of-network phone: (888) 532-5246
  • Email: preauth@texasmutual.com
  • Fax: (800) 852-1805

Pharmacy benefit manager

  • Optum: (800) 964-2531

Diagnosing occupational injuries

See our highly successful video resources for tips on diagnosing nearly 30 injuries.

How to handle workers' comp patients

See our series on communicating and treating workers' comp patients.