The Texas Department of Insurance, Division of Workers? Compensation (TDI-DWC) seeks input and suggestions regarding the development of a new Plan-Based Audit for insurance carriers and utilization review agents that denied office visits for medical necessity. The Plan-Based Audit sets the scope, methodology, selection criteria, and program area responsibilities as laid out in the Medical Quality Review Procedure. A copy of the proposed Insurance Carrier/Utilization Review Agent Plan-Based Audit can be viewed at http://www.tdi.texas.gov/wc/hcprovider/documents/icuradrplan912.pdf.
The Medical Advisor approved a Medical Quality Review Annual Audit Plan which was adopted by the Commissioner of Workers? Compensation. This Plan-Based Audit is from one of the categories listed on the Medical Quality Review Annual Audit Plan. A copy of the approved Medical Quality Review Annual Audit Plan can be viewed at http://www.tdi.texas.gov/wc/hcprovider/documents/omaauditplan1210.pdf.
Workers? compensation system participants should submit suggestions for this Plan-Based Audit via e-mail to OMA.atlas.TDI@tdi.state.tx.us by 5 p.m. Central Standard Time on Wednesday, September 19, 2012.
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