Texas Administrative Code
Title 28 - INSURANCE
Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
Chapter 42 - MEDICAL BENEFITS
Subchapter B - MEDICAL COST EVALUATION
Section 42.160 - Carrier Desk Audit of Bills
Universal Citation: 28 TX Admin Code ยง 42.160
Current through Reg. 49, No. 38; September 20, 2024
(a) During the audit, the carrier and the provider shall make reasonable attempts to resolve any questions or problems regarding the bill under audit. The provider shall submit to the carrier any additional information requested that is relevant to the audit. If a hospital bill is under review, the hospital shall submit the medical record at the carrier's request.
(b) Every audit shall be documented on the medical audit summary sheet, which shall include the following information:
(1) claimant's name;
(2) IAB claim number;
(3) provider's name, address, and federal tax
identification number;
(4) health
care provider-reviewer's report; and
(5) for each audited item, the following:
applicable code; code description; amount billed; amount paid; and, if
appropriate, amount reduced or denied, accompanied by a sufficient explanation
for each reduction or denial.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
