Workers' Compensation Instructions for Health Care Providers

nurse in exam roomHealth care providers are required to submit bills to workers' compensation carriers via electronic transmission. Providers with fewer than 10 employees and for whom workers' compensation represents less than 10 percent of their business are exempt from this requirement. Learn more about billing procedures and your options.

Checking claim status

Call 800.482.7276 to see if we have a claim on file or to get a claim number. You will need the injured worker's full name and/or Social Security number.

Treatment Guidelines

TDI has adopted the Official Disability Guidelines (ODG) for workers' compensation medical treatment in Texas. The ODG provides evidence-based guidelines to ensure appropriate treatment. DWC also requires MDGuidelines for disability management and return-to-work. Health care providers and payors are required to use both the ODG and MDGuidelines.

HIPAA and workers' compensation

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) does not apply to workers' compensation insurers, workers' compensation administrative agencies, or employers when disclosing protected health information (PHI) as required by state law for workers' compensation purposes.

State law requires workers' compensation system participants to disclose an injured worker's PHI as necessary to process or adjudicate claims or to coordinate care under the workers' compensation system. System participants that make PHI disclosures to other workers' compensation participants as required by the DWC rules are, therefore, exempt from HIPAA rules with regard to those disclosures.

For more information, see Advisory 2003-05 or the Texas Department of Insurance Workers Compensation Division's downloadable document, HIPAA and Texas Workers' Compensation.