Can workers’ compensation certified networks be TPAs? What about workers’ compensation voluntary or informal networks and other delegated entities?
Anyone collecting premiums or contributions from, or adjusting or settling claims for, residents of this state in connection with annuities or life, health, accident, pharmacy, or workers’ compensation benefits is acting as a TPA and is subject to HB 472’s provisions and the current administrator rules. This is true regardless of whether the entity is also acting as a certified network, voluntary or informal network, or delegated entity. In cases in which one entity is acting as both a TPA and a certified network or as both a TPA and a voluntary or informal network, that entity is required to obtain a TPA COA from the Department under the bill and the current administrator rules.
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