Texas Workers' Compensation

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§ 134.806. Records Excluded from Reporting

(a) Insurance carriers shall not report medical EDI records for health care services:

(1) rendered outside the United States;

(2) related to dates of injury before January 1, 1991;

(3) rendered at a Federal health care facility and the health care facility does not provide the insurance carrier with the data required to be reported;

(4) related to an injured employee’s travel reimbursement as provided in § 134.110 of this title (relating to Reimbursement of Injured Employee for Travel Expenses Incurred); or

(5) related to a request for reimbursement by a health care insurer in accordance with the provisions of Labor Code § 409.0091.

(b) Insurance carriers shall not report interest and penalty payments paid on health care services, medical cost containment expenses, medical bill review expenses or data transmission expenses in medical EDI records.

(c) This section is effective September 1, 2011.

The provisions of this §134.806 adopted to be effective September 1, 2011, 36 TexReg 4136.

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At a Glance:

Title:

§ 134.806. Records Excluded from Reporting

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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