General
The Texas Labor Code allows for payments that are inconsistent with the Texas Department of Insurance, Division of Workers' Compensation's (DWC) Medical Fee Guidelines through pharmacy informal/voluntary networks, and through Texas Labor Code §408.0284 which relates to Durable Medical Equipment (DME) and Home Health Care Services informal/voluntary networks.
- The definition of a Pharmacy Informal/Voluntary Network is found at Texas Labor Code §408.0281, effective June 17, 2011.
- The definition of a DME or Home Health Care Services Informal/Voluntary Network is found in Texas Labor Code §408.0284, effective September 1, 2013.
Informal/voluntary networks (networks) are required to report the following information to the DWC pursuant to Texas Labor Code §408.0282:
- the name of the informal or voluntary network and Federal Employer Identification Number (FEIN);
- an executive contact for official correspondence;
- a toll-free telephone number;
- a list of each insurance carrier with whom the network contracts (name and FEIN); and
- a list of each entity with which the network has a contract or other business relationship that benefit or its entered into on behalf of the insurance carrier, including contact information.
Online Reporting
To implement the requirements of Texas Labor Code §408.0282, DWC has created two online reporting tools. Networks use the appropriate online tools to create a profile and provide the information required by the applicable law. Networks are responsible for the maintaining the accuracy of that profile, including any additions or changes after initial reporting.
Networks have the ability to enter, change, or add information as appropriate. All system participants have access to view the network's profile information, but do not have the ability to make any changes.
- For Pharmacy networks: Informal and Voluntary Network Data Reports
- For DME and home health networks: DME and Home Health Informal Networks Report
If you have any questions regarding these types of networks, e-mail edisupport@tdi.texas.gov.
FAQs
What is an informal network?
The definition of Pharmacy Informal Network may be found in Texas Labor Code §408.0281. The definition of a DME and Home Health Care Services Informal Network may be found at Texas Labor Code §408.0284.
What is a voluntary network?
The definition of a Pharmacy Voluntary Network may be found at Texas Labor Code §408.0281. The definition of a DME and Home Health Care Services Voluntary Informal Network may be found at Texas Labor Code §408.0284.
How do I know if my company is an informal or voluntary network?
Compare your company's business operations to the definitions contained in the respective law. If your company does not meet these definitions, these reporting requirements do not apply.
Are there timeframes and deadlines for networks to report information to DWC?
Yes. There is an initial reporting deadline of 30 days from the effective date of the respective law. For Pharmacy networks, the initial deadline was 30 days from June 17, 2011. For DME or Home Health Care Services networks, the deadline is October 1, 2013.
Any new networks (i.e., pharmacy and DME/Home Health Care Services networks) established after the initial registration period are required to report within 30 days from the date the network is established using this tool.
Are there time-frames and deadlines for reporting changes to the network?
Networks are required to report any changes to the originally reported information not later than the 30th day after the effective date of the change.
Where do I get additional information about notification requirements?
For notification requirements, pharmacy networks and DME/Home Health Car Services networks should review the requirements of Texas Labor Code §408.0281 and §408.0284 respectively.
Who do I contact with questions?
If you have any questions regarding these types of networks, e-mail martha.luevano@tdi.texas.gov or call 512-804-4858.