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.
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.
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.