Through the Old Republic General Insurance Corporation (ORGENCO) Health Care Network (HCN) Carrier Agreement with Coventry, ORGENCO now offers a certified HCN in Texas.
Texas Department of Insurance previously certified the Coventry Health Care Workers Compensation, Inc. DBA Coventry Workers' Comp Network on May 31, 2007. The CERTIFICATE NUMBER is 6087.
Approved HCN Service Areas To view the approved service areas and service area map, please click on this hyperlink: http://www.tdi.state.tx.us/wc/wcnet/networks/coventryhcwc.html
Internet Site to Find Providers Please click on this text to view HCN providers www.talispoint.com/cvty/gbcvtyhcn
Texas HCN Implementation Documents Employer Requirements under Texas Code § 1305.005: Participation in Network; Notice of Network Requirements.
The Notice of Network Requirements document package is the formal notice the employee receives about the HCN. The HCN is effective when your employees are notified.
When an employer elects to provide health care services through their carrier’s HCN, the employer must provide each employee a notice of the network requirements by providing a copy of the “Employee Notification Packet” and obtain a signed “Acknowledgment Form” from each employee. This notification must be done at the time you decide to be part of the HCN, within three (3) days of hiring new employees, and again at the time your company receives notification of an injury.
The Notice of Network Requirements is given to the employee at the following instances:
- Initial HCN Roll Out: §1305.005(d): The insurance carrier shall provide to the employer, and the employer shall provide to the employer’s employees, notice of network requirements, including all information required by Section 1305.451.
- New Hires: §1305.005(e): The employer shall provide to each employee hired after the notice is given under Subsection (d) the notice of and information required under that subsection not later than the third day after the date of hire.
- Time of Injury: §1305.005(g): The employer shall notify an injured employee the notice of network requirements at the time the employer receives actual or constructive notice of an injury.
New Texas HCN Rules - Effective 1/1/2023
Adopted on August 1, 2022, and Effective January 1, 2023:
The Texas Department of Insurance (TDI) has adopted changes to workers' compensation network rules, utilization review rules, and aligned the regulatory text for the Texas Labor Code, the Texas Administrative Code (TAC) and the Texas Insurance Code (TIC).
Please click on this URL to review: https://tdi.texas.gov/rules/2022/index.html
Beginning January 1, 2023, employers must use the new TX HCN Notification Documents which are available on this Internet Page.
If an employer provides an outdated Notice of Network Requirements, there could be a rebuttal that it is not a valid notification and therefore subject to a contested case hearing final determination. The documentation that the employee was provided with the Notice is required to be maintained by the employer. When an injury occurs, and the employer is notified of the injury, the employer should provide the new notice to the injured employee.
Subchapter D. Network Requirements: Acknowledgement Forms 28 TAC §§10.60 - 10.63
The employer and carrier must determine whether the employer or carrier will be responsible for obtaining a signed employee acknowledgment form from each employee and delivering notices to employees, and generally substitute the term "responsible party chosen under subsection (g)" for references to the carrier and employer regarding notifications.
Where this is a dispute regarding whether an employer or carrier properly provided the information required by this section to an employee may be resolved by requesting a benefit review conference to conform to Insurance Code §1305.103 and §1305.451.
Employer Instructions to Implement the Texas HCN
Please click on the text below to download your Texas HCN instructions and documents.
HCN Notice - Worksite Poster (English and Spanish)
Texas HCN Employee Notification Materials - English (initial roll out, new hires & time of injury)
Texas HCN Employee Notification Materials - Spanish (initial roll out, new hires & time of injury)
HCN Implementation Affidavit The following Affidavit is recommended for all Texas HCN implementations, for it serves as your company’s record of the HCN implementation process.
Please click on this text to download the sample affidavit.
Employer Requirements to Document the Delivery of the Texas HCN Notification Materials to Their Employees and Record Keeping of the Texas HCN Acknowledgement Form.
The failure of an employer to establish a standard process for delivering to an employee a notice of network requirements and acknowledgements form for a network that has a service area in which the employee lives, including documentation of delivery of the notice and the date or dates of delivery, creates a rebuttal presumption that the employee has not received the notice of network requirements and is not subject to network requirements.
Failure to return the form will not exempt the employee from the provider network’s rules in the event of the future claim – only an employer’s failure to provide notification will do so. Maintaining a complete record of all acknowledgement forms is important, as it can help support the employer’s case in the event an employee disputes whether the employer provided the notice required.
The Texas Department of Insurance (TDI) has given addition clarification on HCN Employee Notification Documents. If an employee speaks only English, the employer is required to distribute the English version and not the Spanish version. If the employee speaks only Spanish, then the Spanish version should be given to the employee. The Employer may choose to distribute the English and Spanish versions to each employee to ensure they receive a version they understand, however, the employer is NOT REQUIRED to do so.