Welcome to Gallagher Bassett Services’ (GB) Texas Health Care Network (HCN) Internet Site. Through GB’s managed care service relationship with our preferred partner, Coventry, a Texas Health Care Network (HCN) is available for your use.
On behalf of our insurance carriers and their clients, GB will assist all clients training to ensure a successful process when implementing the HCN.
Texas House Bill 7 (HB 7) became law on September 1, 2005. HB 7 abolished the Texas Workers’ Compensation Commission (TWCC) and created the new Division of Workers’ Compensation under the Texas Department of Insurance (TDI).
Texas Code and Texas HCN Requirements
- The Texas Workers' Compensation Commission (TWCC) was abolished and its functions transferred to the newly created Division of Workers' Compensation (DWC) of the Texas Department of Insurance (TDI)
- Creation of workers' compensation Health Care Networks (HCN) to improve outcomes and lower the cost of claims by focusing on evidence-based care and return-to-work
- HCNs are configured to include multiple entities: the insurance carriers, utilization review, medical provider network, case management, and provider bill review system
- HCNs must include a new Return-to-Work (RTW) program
Texas Insurance Code Chapter 1305: Workers Compensation Networks
Texas Labor Code – § 413.021: Return to Work Coordination Services
- Specifies the requirement of the initial nurse case management evaluations on all claims
Effective January 1, 2011 and per House Bill 473: voluntary or informal networks, more commonly known as preferred provider organizations (PPO), to be dissolved or certified as a Workers’ Compensation Network under TX Labor Code by January 1, 2011. All health care not covered under a certified network contract will be reimbursed according to State adopted fee-schedules or, where fee-schedules do not apply, using the usual and customary standard effective January 1, 2011.
Texas Health Care Network Benefits
- PPO Discounts can be applied under a HCN
- Increased Employer medical control
- Chiros cannot be primary treaters
- Control over Provider Choices – injured workers can only change Treating Doctors one time without seeking approval to do so
- Treating Doctor – Network chooses which specialties may serve as treating doctors
- Referral Control – an injured worker may not go to a specialist without the referral of their Treating Doctor
- Treatment guidelines including ODG and ACOEM
- Use of Medical Disability Advisor (MDA) return-to-work guidelines
- Less Medical Costs – less utilization and less specialty treatment
New Texas HCN Rules - Effective 1/1/2023
Adopted on August 1, 2022, and Effective January 1, 2023:
The Texas Department of Insurance (TDI) has adopted changes to workers' compensation network rules, utilization review rules, and aligned the regulatory text for the Texas Labor Code, the Texas Administrative Code (TAC) and the Texas Insurance Code (TIC).
If you you would like additional TX HCN information and/or regarding programs and services offered by Gallagher Bassett Services, please contact your GB Account Executive.
DISCLAIMER. The content of this Web site is provided for informational purposes only, from a general insurance/risk management perspective, with the understanding that Gallagher Bassett Services, Inc. (GB) is not rendering legal, accounting or other professional advice on specific matters. Accordingly, GB assumes no liability whatsoever in connection with the use of such content. GB recommends that you consult your legal counsel or other professional advisor with respect to your individual situation.
The information provided throughout this Web site is provided from a general insurance/risk management perspective and is NOT legal advice. Gallagher Bassett Services, Inc. (GB) does not provide legal advice as it is not qualified to do so. GB recommends that you seek the advice of legal counsel in order to become fully apprised of the legal implications related to the information provided above as such implications are highly dependent on the unique facts and circumstances applicable to an individual situation.