TWCC FINES CARRIERS AFTER AUDITS

The Texas Workers’ Compensation Commission completed audits of several insurance carriers for compliance with preauthorization processing requirements and for performance on retrospective review of medical bills for preauthorized services for injured workers. Penalties totaling $399,090 were issued to seven carriers as a result of the audits.

TWCC said the audits, conducted by its Compliance and Practices Division, showed that only one of the audited carriers met or exceeded the compliance standard for processing preauthorization requests. Two carriers met or exceeded the compliance standard for appropriateness of denials and reductions of preauthorized services.

Robert L. Shipe, TWCC executive director, said Commission rules require 95 percent compliance with audit standards. However, TWCC encourages all system participants to strive for 100 percent compliance. On average, the carriers had 86.4 percent compliance with preauthorization processing requirements and 91.9 percent compliance with the standards for reviewing medical bills related to the preauthorized services.