DWC Forms FAQ
DWC Forms are located at www.tdi.state.tx.us/forms/form20.html
Q: I do not have Adobe Acrobat on my computer. Is there another way to obtain the forms we need to use in our office?
A: All you need to open and fill out TDI-DWC forms is Adobe Acrobat Reader and it is free. You can download Adobe Acrobat Reader by going to http://www.adobe.com/.
Q: I would like to request a clarification of Advisory 2004-09. It states that "Forms that are filed with the Division must contain the new form standards, including the barcodes and footers beginning September 30, 2004." Forms PLN-1 and PLN-11 are filed with the Division, however, they are specifically mentioned in the list of forms that "should be generated using the new standards as soon as possible, but must be revised no later than Aug 31, 2005." Which deadline should apply to these forms?
A: Although the PLN-1 and PLN-11 are sent to TDI-DWC, the Advisory specifically exempts them from the September 30, 2004 deadline. Therefore, the August 31, 2005 deadline applies to these forms.
Q: Is it possible for me to receive the TDI-DWC (Texas Department of Insurance, Division of Workers' Compensation) forms in Word format?
A: TDI-DWC forms with barcode will only be provided in the interactive PDF format. With the exception of the PLN forms, the Division will no longer provide Word or WordPerfect versions of Division forms.
Q: I was reviewing Advisory 2004-09 and I see that all TDI-DWC forms have been updated to show the TDI-DWC claim number located at the top right portion of the form. When I printed the DWC-066 form from your website I am not seeing this box at the top right corner. I do see it located in the Employee area. Please let me know if this is the most updated form and the correct one to be using.
A: The DWC-066 is an exception to the rule and does not have the TDI-DWC claim number in the upper right corner. The 10/05 version of the DWC-066 on the website is the most current edition.
Q: In the past we created our own versions of TDI-DWC forms. Can these alternate forms still be used?
A: Alternate forms must use TDI-DWC specifications (please see the bar code values Excel document in the form developer's kit), and must be tested and approved for use by TDI-DWC before they can be used. To request approval, e-mail a copy of the alternate form to the TDI-DWC at WebStaff@tdi.state.tx.us.
Q: Can data be merged into the TDI-DWC interactive PDF forms from a database, like we were doing with the MS Word merge versions?
A. Yes, but this requires that the user owns or obtains Adobe Acrobat software or software that is capable of importing data into the PDF form fields form a database. In addition, the PDF forms support importing data in XML, FDF, or text format. Exporting data from the PDF form to a data file is also possible with the same software required for importing.
Q: When should I begin faxing all DWC Form-022s to the Central Office? As of now, I fax to each field office.
A: Continue faxing these to each field office as they will be processed there. In the future we will be implementing a statewide fax solution and you will use one fax number regardless of location. An Advisory will be published once this functionality exists.
Q: Do we have to put the bar code on the HCFA (CMS) 1500 or the UB (CMS) 92?
A: No. The HCFA-1500 (CMS-1500) and the UB-92 (CMS-92) are not TDI-DWC forms. The instructions for how to complete them for workers' compensation bills are in the Texas Clean Claim & eBill Workers' Compensation Companion Guide. Barcodes are not required on the actual medical bills.
Q: Will the Central Office address listed in Advisory 2004-10 apply to claim submission or will this address apply for appeals only? Is there a way to send claims electronically?
A: TDI-DWC has no jurisdiction over DOL (Department of Labor) requirements, which are in no way superseded by Advisory 2004-10. Our Advisory refers only to Texas state workers' compensation filing requirements. Any and all TDI-DWC mail can be sent to the Central Office, including claim submission mail. Appeals should always be filed with Central Office Hearings Divisions. Claims reported by injured employees can be filed online at this time. Claims must be reported by employers to their insurance carriers who will subsequently file them with the Division electronically.
Q: We are a pharmacy management software company that currently allows our pharmacy customers to print their own DWC Form-066 form. Does the new barcode change affect the pharmacy prescription form for medicine dispensed? Do we need to program a barcode on the DWC Form-066, even though the form is not submitted to the Division by our pharmacy customers?
A: If a customer generates their own DWC Form-066 form, it may have the DWC-specified barcode on it. If the one on our website is used, the barcode is already there. This form is not filed with the TDI-DWC, but rather is filed with the insurance company. It may come to the TDI-DWC at a future time as documentation related to a medical dispute on a pharmacy issue. Since the form is not filed with the TDI-DWC, customers using their own DWC Form-066 forms are not required to have barcodes.
Q: Several years ago, we were required to mail forms DWC Form-061, DWC Form-073, and DWC Form-069 to the TDI-DWC. However, more recently, we have only mailed those forms to the insurance carrier. I have received the Advisory 2004-10 regarding Change of Primary Mailing Address to the Central Office effective October 15, 2004. It states the purpose is to allow claim parties to view claim documents online. Are any of these forms required to be sent to the Central Office, or do I just mail them to the carrier?
A: The DWC Form-061 is an obsolete form and is not required to be filed with anyone anymore. The DWC Form-069 is and has always been required to be filed with the carrier, the injured worker, and the TDI-DWC. This should continue to happen. The DWC Form-073 is only required to be filed with the carrier at this time, but if a copy is sent to TDI-DWC, it will be filed with the online claim file.
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Last updated: 03/30/2012
