Skip to Top Main Navigation Skip to Left Navigation Skip to Content Area Skip to Footer
Texas Department of Insurance
Topics:   A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All

Workers' Compensation Health Care Networks Forms

If the form is a fillable PDF, learn how to enable all fillable form features.

TDI Form Number Description File Format Language
LHL705

Workers’ Compensation Health Care Network Application

PDF English
LHL708

Workers' Compensation Network Access Plan Checklist

WC Network Access Plan Checklist

PDF English
LHL720

Workers' Compensation Health Care Network Provider Contract Checklist

PDF English
LHL721

Workers’ Compensation Network Contract with Insurance Carrier Contract Requirements Checklist

PDF English
LHL722

Workers' Compensation Health Care Network Management Contract Checklist

PDF English
SN003

Workers Comp Network Sample Contingency Plan

PDF English
SN008

Workers Comp Network Sample QI Report

PDF English

For more information, contact: MCQA@tdi.texas.gov