Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (DWC) recently released its 2022 Insurance Carrier Performance Based Oversight (PBO) results.
The DWC regularly evaluates insurance carriers and health care providers for compliance with Texas Labor Code §402.075 and 28 Texas Administrative Code §180.19.
Performance Based Oversight (PBO) is a review of Insurance carriers’ and health care providers’ performance in selected areas of compliance.
The purpose of PBO is to:
- Set performance expectations
- Reward excellence
- Encourage continuous improvement
For 2022, insurance carriers were assessed on the following measures:
- 1. Timely payment of initial temporary income benefits by the insurance carrier – 50% weight.
- 2. Timely processing of initial medical bills by the insurance carrier – 30% weight.
- 3. Timely processing of request for reconsideration medical bills by the insurance carrier – 10% weight.
- 4. Timely submission of initial payment data via Electronic Data Interchange (EDI) – 5% weight.
- 5. Timely submission of medical bill processing data via EDI – 5% weight.
The DWC reviewed 136 insurance carriers with the following results:
- 41 had scores placing them in the high performer tier
- 82 were in the average performer tier
- 13 had a score placing them in the poor performer tier
The 2022 PBO assessment results and a list of the insurance carriers that were reviewed are posted on the Texas Department of Insurance (TDI) website.
More information on PBO and the 2022 assessment is available on the TDI website. DWC will assess health care providers separately in 2023.