Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 15 - WORKERS COMPENSATION MEDICAL FEE SCHEDULE & EXHIBIT A › Subchapter 4 - ADMINISTRATION › Section 12-15-94 - Payment by employer

Current through June,
				2024
(a) The employer
				shall pay for all medical services which the nature of the compensable injury
				and the process of recovery require. The employer is not required to pay for
				care unrelated to the compensable injury.
(b) When a provider of service notifies or
				bills an employer, the employer shall inform the provider within sixty calendar
				days of such notification or billing should the employer controvert the claim
				for services. Failure of the employer to notify the provider of service shall
				make the employer liable for services rendered until the provider is informed
				the employer controverts additional services.
(c) The employer, after accepting liability,
				shall pay all charges billed within sixty calendar days of receipt of such
				charges except for items where there is a reasonable disagreement. If more than
				sixty calendar days lapse between the employer's receipt of an undisputed
				billing and date of payment, payment of billing shall be increased by one per
				cent per month of the outstanding balance. In the event of disagreement, the
				employer shall pay for all acknowledged charges and shall notify the provider
				of service, copying the claimant, of the denial of payment and the reason for
				denial of payment within sixty calendar days of receipt. Furthermore, the
				employer's denial must explicitly state that if the provider of service does
				not agree, the provider of service may file a "BILL DISPUTE REQUEST" to include
				a copy of the original bill with the director within sixty calendar days after
				postmark of the employer's objection, and failure to do so shall be construed
				as acceptance of the employer's denial.
(d) In the event a reasonable disagreement
				relating to specific charges cannot be resolved, the employer or provider of
				service may request intervention by the director in writing with notice to the
				other party. Both the front page of the billing dispute request and the
				envelope in which the request is mailed shall be clearly identified as a
				"BILLING DISPUTE REQUEST" in capital letters and in no less than ten point
				type. The director shall send the parties a notice and the parties shall
				negotiate during the thirty-one calendar days following the date of the notice
				from the director. If the parties fail to come to an agreement during the
				thirty-one calendar days, then within fourteen calendar days following the
				thirty-one day negotiating period, either party may file a request, in writing,
				to the director to review the dispute with notice to the other party. The
				director shall send the parties a second notice requesting the parties file
				position statements, with substantiating documentation to specifically include
				the amount in dispute and a description of actions taken to resolve the
				dispute, within fourteen calendar days following the date of the second notice
				from the director. The director shall review the positions of both parties and
				render an administrative decision without hearing. A service fee of up to $500
				payable to the State of Hawaii General Fund will be assessed at the discretion
				of the director against either or both parties who fail to negotiate in good
				faith. The decision of the director is final and not appealable.