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Advisory 2000-05

Notice of Forms Revision

The Executive Director, under the authority granted by the Texas Labor Code, §402.042 has revised the following forms: TWCC-60, Medical Dispute Resolution Request/Response and TWCC-62, Explanation of Benefits. The Executive Director has revised the TWCC-67, Instructions for Completing the HCFA-1500 and TWCC-68, Instructions for Completing the UB-92. TWCC also adopts the use of TWCC-48, Request for Travel Reimbursement, for injured employees to use when requesting reimbursement for travel expenses related to their compensable injury, according to Rule 134.6

System participants may use the new forms and instructions on or after July 15, 2000. In order to allow participants time to make changes to their business operations, use of the new forms and instructions will be available on our Web page at and may be downloaded and copied.

Signed this 4th day of August, 2000

Leonard W. Riley, Executive Director

Distribution: Commission Representatives, Medical Associations, TWCC Staff, Public Information List