| (a) Insurance carriers may submit claim EDI records
directly to the division or contract with an external trading partner
to submit the records on the insurance carrier's behalf.
(b) Each insurance carrier, including those using external
trading partners, must designate one person to the division as the
EDI compliance coordinator and provide the person's name, working
title, mailing address, email address, and telephone number in the
form and manner prescribed by the division. The EDI compliance coordinator
must:
(1) be an employee of the insurance carrier with knowledge
and experience in EDI reporting, who is responsible for EDI reporting;
(2) receive and appropriately disperse data reporting
information received from the division; and
(3) serve as the central compliance control for data
reporting under this subchapter.
(c) At least five working days before sending its first
transaction to the division under this subchapter, the insurance carrier
must send a notice to the division. The notice must be in the form
and manner prescribed by the division. The notice must include the
name of the insurance carrier, the insurance carrier's FEIN, the insurance
carrier's TXCOMP customer number, the name of the trading partners
authorized to conduct claim EDI transactions on behalf of the insurance
carrier, the FEIN of the trading partners, and the EDI compliance
coordinator's signature.
(d) The insurance carrier must report changes required
under subsections (b) and (c) within five working days of any amendment
to data sharing agreements, including adding or removing any trading
partners or changing the EDI compliance coordinator. Failure to timely
submit updated information may result in the rejection of claim EDI
records.
(e) At least five working days before sending its first
test transaction to the division under this subchapter, the insurance
carrier or trading partner sending the claim EDI transmission must
send a notice to the division. The notice must be in the form and
manner prescribed by the division. The notice must include the entity's
name; FEIN; nine-digit postal code; address; and the technical contact's
name, address, phone number, and email address. The insurance carrier
or trading partner must report changes within five working days of
any amendment to the information required to be reported.
(f) Insurance carriers and trading partners must successfully
complete claim EDI Release 3.1.4 testing before transmitting any production
claim EDI Release 3.1.4 data to the division. Trading partners must
receive approval to submit data for at least one insurance carrier
before initiating the testing process. Insurance carriers and trading
partners must submit each transaction type during the testing process
to ensure that it can be successfully processed by the division. The
division will not approve an insurance carrier or trading partner
for production submissions until the insurance carrier or trading
partner has met the requirements for testing as described in the Texas
Claim EDI Release 3.1.4 Implementation Guide.
(g) Once an insurance carrier or trading partner has
met the requirements of subsection (f), the insurance carrier or trading
partner is approved to report claim EDI data to the division. Only
approved insurance carriers or trading partners may report claim EDI
data to the division.
(h) The division may suspend the ability for an insurance
carrier or trading partner to report claim EDI if it does not meet
the requirements for an approved trading partner as described in the
Texas Claim EDI Release 3.1.4 Implementation Guide. The division will
notify the insurance carrier's claim EDI compliance coordinator in
writing in advance of the suspension.
(i) Loss of approval to report claim EDI does not relieve
an insurance carrier of the duty to report claim information or notices
to the division under §124.2 of this title (concerning Insurance
Carrier Notification Requirements).
(j) Insurance carriers are responsible for the acts
or omissions of their trading partners. The insurance carrier commits
an administrative violation if the insurance carrier or its trading
partner fails to timely or accurately submit claim EDI records.
(k) An insurance carrier must provide to the division
the EDI compliance coordinator's contact information required by this
subsection no later than 90 days after the adoption of this subchapter.
Except as otherwise provided by this subsection, an insurance company
that obtains a certificate of authority to write workers' compensation
insurance in Texas after the adoption of this subchapter, or an employer
or group of employers who are authorized to self-insure by DWC or
TDI after the adoption date of this subchapter, must provide the EDI
compliance coordinator's contact information required by subsection
(b) to the division no later than the 30th day after the insurance
company's certificate of authority or authorization to self-insure
becomes effective.
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