California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.5.0 - Rules for Medical Treatment Billing and Payment on or After October 15, 2011 › Section 9792.5.13 - Independent Bill Review - Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If the request for independent bill
					 review involves the application of the Official Medical Fee Schedule (OMFS) for
					 the payment of medical treatment services or goods as defined in Labor Code
					 section
					 4600, the
					 independent bill reviewer shall apply the provisions of sections
					 9789.10 to
					 9789.111 to determine the
					 additional amounts, if any, that are to be paid to the provider.
(b) If the request for independent bill
					 review involves the application of a contract for reimbursement rates under
					 Labor Code section
					 5307.11 for the
					 payment of medical treatment services as defined in Labor Code section
					 4600, the
					 independent bill reviewer shall apply the contract to determine the additional
					 amounts, if any, that are to be paid to the provider.
(c) If the request for independent bill
					 review involves the application of the Medical-Legal Fee Schedule (M/L Fee
					 Schedule) for services defined in Labor Code section
					 4620, the
					 independent bill reviewer shall apply the provisions of sections
					 9793-9795 and
					 9795.1 to
					 9795.4 to determine the additional
					 amounts, if any, that are to be paid to the provider.
(d) In applying this section, the independent
					 bill reviewer shall apply the provisions of the OMFS, the M/L Fee Schedule,
					 and, if applicable, the contract for reimbursement rates under Labor Code
					 section
					 5307.11, as if
					 the bill is being reviewed for the first time. The independent bill review
					 shall also apply as necessary all billing, payment, and coding rules adopted
					 under this Article.
1. New
						section filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to
						Government Code section
						11346.1(d)
						(Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL
						by 7-1-2013 or emergency language will be repealed by operation of law on the
						following day.
2. New section refiled 7-1-2013 as an emergency;
						operative 7-1-2013 (Register 2013, No. 27). A Certificate of Compliance must be
						transmitted to OAL by 9-30-2013 or emergency language will be repealed by
						operation of law on the following day.
3. New section refiled
						9-30-2013 as an emergency; operative 10-1-2013 (Register 2013, No. 40). A
						Certificate of Compliance must be transmitted to OAL by 12-30-2013 or emergency
						language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 9-30-2013 order, including
						amendment of subsection (d), transmitted to OAL 12-30-2013 and filed 2-12-2014;
						amendments effective 2-12-2014 pursuant to Government Code section
						11343.4(b)(3)
						(Register 2014, No. 7).
Note: Authority cited: Sections
						  133,
						  4603.6,
						  5307.3 and
						  5307.6, Labor
						  Code. Reference: Sections
						  4060,
						  4061,
						  4061.5,
						  4062,
						  4600,
						  4603.2,
						  4603.3. 4603.4, 4603.6, 4620, 4621,
						  4622, 4625, 4628 and 5307.6, Labor
						  Code.