Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.750 - Insurer Electronic Medical Report Filing to the Division

Current through Reg. 50, No. 138; July 16, 2024
(1) Effective 3/16/05, all required medical
				reports shall be electronically filed with the Division by all
				insurers.
(2) Required data
				elements shall be submitted in compliance with the MEIG.
(3) The Division will notify the Sender on
				the "Medical Bill Acknowledgement" of the corrections necessary for rejected
				medical reports to be electronically re-filed with the Division. An insurer
				shall ensure all rejected medical reports are corrected and resubmitted
				successfully to meet the filing requirements of subsection
				 69L-7.750(5),
				F.A.C.
(4) Any Sender who
				experiences a catastrophic event resulting in the insurer's failure to meet the
				reporting requirements in subsection
				 69L-7.740(5),
				F.A.C., shall submit a written or electronic request within 15 business days
				after the catastrophic event to the Division for approval to submit in an
				alternative reporting method and an alternative filing timeline. The request
				shall contain a detailed explanation of the nature of the event, date of
				occurrence, and measures being taken to resume electronic submission. The
				request shall also provide an estimated date by which electronic submission of
				affected electronic data interchange or EDI filings, as defined in the MEIG,
				will be resumed. Approval shall be obtained from the Division's Bureau of Data
				Quality and Collection, 200 East Gaines Street, Tallahassee, Florida
				32399-4226. Approval to submit in an alternative reporting method and an
				alternative filing timeline shall be granted by the Division if a catastrophic
				event prevents electronic transmission.
(5) When filing any medical report
				replacement that corrects or replaces a previously accepted medical report, the
				sender shall use the same control number as the original transaction using bill
				submission reason code "03". The replacement report shall contain all
				information necessary to process the medical report including all services and
				charges from the medical bill as billed by the health care provider and all
				payments made by a claim administrator or entity acting on behalf of an insurer
				to the health care provider. Additionally, after being notified by the Division
				that data has been accepted with errors or that data previously accepted has
				been deemed inaccurate, a claim administrator or entity acting on behalf of an
				insurer shall correct or replace the inaccurate data, using the same control
				number as the original transaction and using bill submission reason code "03".
				The insurer or the entity acting on behalf of the insurer shall respond to a
				written request from the Division to review, correct, and re-submit accurate
				data. Each Division written request shall have a specified timeline to which
				the insurer or entity acting on behalf of an insurer shall adhere.
(6) Each insurer shall be responsible for
				ensuring the accurate completion of the Medical EDI Bill Record Layouts
				Revision F for Records 09, 10, 11 and 90 as defined in and in accordance with
				the MEIG's phase-in schedule, as denoted below.
(a) Senders with Sender FL ID numbers 001 -
				199, as defined in the MEIG, shall begin testing 150 days after the effective
				date of this rule and shall complete the testing process with the new Revision
				"F" record layouts within 195 days after the effective date of this
				rule.
(b) Senders with Sender FL ID
				numbers 200 - 899, as defined in the MEIG, shall begin testing 195 days after
				the effective date of this rule and shall complete the testing process with the
				new Revision "F" record layouts within 240 days after the effective date of
				this rule.
(c) Senders with Sender
				FL ID numbers 900 and above, as defined in the MEIG, shall begin testing 240
				days after the effective date of this rule and shall complete the testing
				process with the new Revision "F" record layouts within 285 days after the
				effective date of this rule.
(d)
				The Division will, resources permitting, allow senders that volunteer to
				complete the test transmission processes earlier than the schedule denoted
				above. Each voluntary sender shall still have 45 days from the start date of
				testing to complete the test transmission to production transmission processes,
				for all Medical EDI Bill Records, that comply with requirements set forth and
				defined in the MEIG.