Texas Administrative Code
Title 28 - INSURANCE
Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING
Subchapter B - INSURANCE CARRIER CLAIM ELECTRONIC DATA INTERCHANGE REPORTING TO THE DIVISION
Section 124.105 - Records Required to be Reported
Universal Citation: 28 TX Admin Code ยง 124.105
Current through Reg. 49, No. 38; September 20, 2024
(a) Insurance carriers must submit claim EDI records when the insurance carrier:
(1) takes action on or events occur in a
claim as described in §
124.2
of this title (concerning Insurance Carrier Notification
Requirements);
(2) corrects
division-identified errors in a previously accepted electronic record as
provided in § 124.104(b) of this title (concerning Reporting
Requirements);
(3) corrects
insurance carrier-identified errors in a previously accepted electronic record
as provided in §
124.2(b)(4)
of this title;
(4) discovers that a
claim EDI record should not have been submitted to the division, and the
division had previously accepted the claim EDI record; or
(5) receives a request from the division for
claim EDI records.
(b) Regardless of the application acknowledgment code returned in an acknowledgment, claim EDI records are not considered received by the division if the claim EDI record:
(1) contains data,
which does not accurately reflect the code value or actions taken when the
insurance carrier processed information or acted on the claim; or
(2) fails to contain a conditional data
element and the mandatory trigger condition existed at the time the insurance
carrier acted on the claim.
(c) Claim EDI records submitted in the test environment are not considered received and do not comply with the reporting requirements of this section.
(d) Claims with a date of injury on or after January 1, 1991, must be reported in accordance with the requirements of this chapter (concerning Insurance Carriers: Notices, Payments, and Reporting).
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