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Workers' Compensation Health Care Network (WCNet) Contract Requirements

Provider Requirements

In order to participate in the provider panel of a certified WCNet (network) a provider must enter into a written agreement with the network. A network's provider contract must include certain provisions which are required under TIC §1305.152 and 28 TAC §10.42(b). Some of the provisions that are mandatory in a network-provider contract include, but are not limited to:

  • Injured employee will be "Held Harmless"
  • Provider agrees to follow the network's treatment guidelines
  • Network will not engage in retaliatory action
  • Provider will comply with all applicable state & federal requirements

To see all of the network-provider contract requirements, please refer to the referenced statute and rule.

FIN550 - Provider Contract Checklist

Other Applicable Statutes and Rules

Carrier Requirements

In order to obtain the authority to operate as a certified WCNet (network) an applicant must enter into a written agreement with an insurance carrier. A network's insurance carrier contract must include certain provisions which are required under TIC §1305.154 and 28 TAC §10.41(a). Some of the provisions that are mandatory in a network-carrier contract include, but are not limited to:

  • Injured employee will be "Held Harmless"
  • Carrier retains ultimate responsibility for compliance
  • Network's role is to provide certain required services
  • Network-carrier contract will comply with all applicable state & federal requirements

To see all of the network-carrier contract requirements, please refer to the referenced statute and rule.

FIN551 - Carrier Contract Checklist

Other Applicable Statutes and Rules

Delegated Entities Requirements

In order to delegate contracting with providers for care; provider credentialing; the operation of a quality improvement program; or the operation of a complaint system to a third party, a certified WCNet (network) must enter into a written agreement with the third party, i.e., the delegated entity (DE).

A network's DE contract must require the DE to be subject to all the requirements of Chapter 1305 of the TIC and related rules. Some of the requirements that apply to a network-DE contract include, but are not limited to the following:

A network-DE contract must be executed when submitted to the department for approval and must include the network's contingency plan for use in the event that the network must re-assume any/all delegated functions. Network-DE contracts that are not executed will not be reviewed by the department for compliance.

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Last updated: 10/25/2017

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