DWC Issues Second 15-day Notice for Modifications to Proposed Independent Bill Review (IBR), Billing and Payment Regulations, and Third 15-day Notice for Modifications to Proposed Independent Medical Review (IMR) Regulations By Press Release - December 12, 2013
The Division of Workers’ Compensation (DWC) has posted a second 15-day notice of modification to the Standardized Paper Billing and Payment, and Electronic Billing and Payment regulations, and a third 15-day notice of modifications to the proposed Independent Medical Review (IMR) regulations, to the DWC website. Members of the public are invited to present written comments regarding the proposed modifications to dwcrules@dir.ca.gov until 5 p.m. on December 26, 2013.
The proposed modifications for the IBR and billing regulations include:
Revised forms for providers to request a second bill review and IBR
Addition of new subdivision providing that the 90-day time limit for requesting a second review may be extended by mutual written agreement between the provider and the claims administrator
Revision limiting the number of separate IBR requests that can be consolidated for a single IBR determination to a maximum of 20
Clarification of the Medical Billing and Payment Guide and the Electronic Medical Billing and Payment Companion Guide version numbers and effective dates
Revision of the effective date of new forms and instruction manuals to coincide with the effective date of the regulations in order to preclude retroactive application
Clarification of the usage of several fields in the new CMS 1500 form
Revisions to coordinate the elements required to identify documentation supporting paper bills and electronic bills.
The proposed modifications for the IMR and regulations include:
Revision to the instructions of the Application for Independent Medical Review (DWC Form IMR) to clarify the consequence of a decision to not participate in the IMR process
Clarification that an IMR determination cannot issue based solely on information provided by a utilization review determination.
The notice, text of the regulations, and forms can be found on the proposed regulations pages for IMR and IBR.
###
P.O. Box 420603 · San Francisco, CA · 94142-0603 · www.dir.ca.gov
Adjuster / Examiner Claims Examiner Santa Ana Unified School District Santa Ana, CA
__May11th2017.gif)
.gif)