To help streamline the billing process, complete the correct DWC billing form and make sure to fill out all required fields.
- The CMS-1500 is used for all physician services and ambulatory surgical services (use the instructions on the DWC-67).
- Use the UB-04 for all facility charges, including hospital, inpatient and outpatient services, and home health services (use the instructions on the DWC-68).
- Fill out the DWC-66 for all pharmacy services (this form already includes the proper instructions).
See DWC Rule 133.210 for documentation requirements. You will need to provide a valid state medical license number, valid diagnosis codes (ICD-9 codes), procedure codes and included modifiers for procedure codes when required. Also, provide valid NABP and FID numbers, a physical address in Box 32 for ambulance bills and use the required CPT codes from the current CPT code book.
Bills for Texas Mutual should be submitted to Jopari Solutions (payer ID: 22945). For more information, contact Jopari Solutions at (866) 269-0554.
Health care providers have 95 days from the date of service (DOS) to submit a bill and 10 months from the DOS to submit an appeal.
The denied/original EOB must be included with the original bill as proof of documentation. In most cases, the bill was denied as a duplicate due to not having the EOB attached.
There are certain situations that require both a preauthorization number and out-of-network approval on a medical bill.
Preauthorization addresses medical necessity and not compensability. There are situations when a provider can get preauthorization for conditions that are not related. Texas Mutual does not recognize preauthorization as a guarantee of payment.
If your services are set up through Align, or you have a contract with them, the bill must be submitted to the Align network.
You can retrieve claim numbers by calling our Healthcare Provider Line at (888) 53-CLAIM (532-5246) and selecting Option 2 and then Option 1.
You can access your EOB online and check the status of a bill through Texas Mutual’s Claim Status and EOB Search. You will need to provide the injured worker's social security number, FEIN, and date of service to check bill status.
Carriers have 45 days to review and process your bill. After 30 days, you can check the status of your Texas Mutual bill online or by calling (888) 53-CLAIM (532-5246)
The documentation you submitted does not support the CPT code billed. If you are billing an FCE, we confirm that the injured worker rode a stationary bike or ran on a treadmill for the cardio portion of the test. If you billed for an office visit, contact us on why the documentation did not support the CPT code.
You can fill out the WorkWell, TX network complaint form to submit a grievance about a bill.