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 9792.5.0 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in this article:
(a) "Assignee" means a person or entity that
					 has purchased the right to payments for medical goods or services from the
					 health care provider or health care facility and is authorized by law to
					 collect payment from the responsible payer.
(b) "Billing Agent" means a person or entity
					 that has contracted with a health care provider or health care facility to
					 process bills for services provided by the health care provider or health care
					 facility.
(c) "Claims
					 Administrator" means a self-administered insurer providing security for the
					 payment of compensation required by Divisions 4 and 4.5 of the Labor Code, a
					 self-administered self-insured employer, or a third-party administrator for a
					 self-insured employer, insurer, legally uninsured employer, or joint powers
					 authority.
(d) "Health Care
					 Facility" means any facility as defined in Section
					 1250
					 of the Health and Safety Code, any surgical facility which is licensed under
					 subdivision (b) of Section
					 1204
					 of the Health and Safety Code, any outpatient setting as defined in Section
					 1248
					 of the Health and Safety Code, any surgical facility accredited by an
					 accrediting agency approved by the Licensing Division of the Medical Board of
					 California pursuant to Health and Safety Code Sections
					 1248.15
					 and
					 1248.4,
					 or any ambulatory surgical center or hospital outpatient department that is
					 certified to participate in the Medicare program under Title XVIII
					 (42 U.S.C. Sec.
					 1395 et seq.) of the federal Social Security
					 Act.
(e) "Health Care Provider"
					 means a provider of medical treatment, goods and services provided pursuant to
					 Labor Code section
					 4600, including
					 but not limited to a physician, a non-physician or any other person or entity
					 who furnishes medical treatment, goods or services in the normal course of
					 business.
(f) "Physician" includes
					 physicians and surgeons holding an M.D. or D.O. degree, psychologists,
					 acupuncturists, optometrists, dentists, podiatrists, and chiropractic
					 practitioners licensed by California state law and within the scope of their
					 practice as defined by California state law.
(1) "Psychologist" means a licensed
					 psychologist with a doctoral degree in psychology, or a doctoral degree deemed
					 equivalent for licensure by the Board of Psychology pursuant to Section
					 2914
					 of the Business and Professions Code, and who either has at least two years of
					 clinical experience in a recognized health setting or has met the standards of
					 the National Register of the Health Service Providers in Psychology.
(2) "Acupuncturist" means a person who holds
					 an acupuncturist's certificate issued pursuant to Chapter 12 (commencing with
					 Section 4925) of Division 2 of the Business
					 and Professions Code.