Plain English Breakdown
The official text states bills shall be 'reprocessed and paid, as specified' but does not define what those specifications entail in this excerpt.
Workers' Compensation Contract Disclosure Rules
This law requires payors to share specific contract details with doctors when a contract is the reason for changing or denying payment, and it sets new rules requiring physicians to sign requests for medical treatment.
What This Bill Does
- Requires explanations of benefits or review to include contact information if a contract is the reason for adjusting, changing, or denying payment.
- Mandates that payors provide the state-assigned network ID number and an email address so providers can request copies of contracts.
- States that simply naming the medical provider network does not meet the requirement to share contract details.
- Requires payors to send a copy of the underlying contract within 30 business days if requested by a doctor or their agent.
- Limits requests for contract copies to once every 365-day period per requestor.
- Reorders bills and requires payment as specified if the contract is not sent within the required time frame.
Who It Names or Affects
- Payors who handle workers' compensation claims
- Medical providers such as doctors, surgeons, chiropractors, acupuncturists, and hospitals
Terms To Know
- Explanation of Review or Benefits
- A document sent to a provider that explains how much was paid and why any amount was changed, adjusted, or denied.
- Underlying Contract
- The agreement between the payor and a network of doctors that sets specific rates for medical services.
- Rendering Medical Provider
- The doctor or health care professional who actually provided the treatment to the injured worker.
Limits and Unknowns
- The bill does not specify an effective date in the provided text.
- The exact penalties for failing to send a contract within 30 days are described only as reprocessing and paying 'as specified,' without listing specific fine amounts.