Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › BILLING › Section 296-20-125 - Billing procedures

Current through Register Vol. 24-14, July 15, 2024
All services rendered must be in accordance with the medical
				  aid rules, fee schedules, and department policy. The department or self-insurer
				  may reject bills for services rendered in violation of these rules. Workers may
				  not be billed for services rendered in violation of these rules.
(1) Bills must be itemized on department or
				self-insurer forms or other forms which have been approved by the department or
				self-insurer. Bills may also be transmitted electronically using department
				file format specifications. Providers using any of the electronic transfer
				options must follow department instructions for electronic billing. Physicians,
				osteopaths, advanced registered nurse practitioners, chiropractors,
				naturopaths, podiatrists, psychologists, and registered physical therapists use
				the current national standard Health Insurance Claim Form (as defined by the
				National Uniform Claim Committee) with the bar code placed 2/10 of an inch from
				the top and 1 1/2 inches from the left side of the form. Hospitals use the
				current National Uniform Billing Form (as defined by the National Uniform
				Billing Committee) for institution services and the current national standard
				Health Insurance Claim Form (as defined by the National Uniform Claim
				Committee) with the bar code placed 2/10 of an inch from the top and 1 1/2
				inches from the left side of the form for professional services. Hospitals
				should refer to chapter 296-23A WAC for billing rules pertaining to
				institution, or facilities, charges. Pharmacies use the department's statement
				for pharmacy services. Dentists, equipment suppliers, transportation services,
				vocational services, and massage therapists use the department's statement for
				miscellaneous services. When billing the department for home health services,
				providers should use the "statement for home nursing services." Providers may
				obtain billing forms from the department's local service locations.
(2) Bills must specify the date and type of
				service, the appropriate procedure code, the condition treated, and the charges
				for each service.
(3) Bills
				submitted to the department must be completed to include the following:
(a) Worker's name and address;
(b) Worker's claim number;
(c) Date of injury;
(d) Referring doctor's name and L & I
				provider account number;
(e) Area
				of body treated, including the current federally adopted ICD-CM code(s),
				identification of right or left, as appropriate;
(f) Dates of service;
(g) Place of service;
(h) Type of service;
(i) Appropriate procedure code, hospital
				revenue code, or national drug code;
(j) Description of service;
(k) Charge;
(l) Units of service;
(m) Tooth number(s);
(n) Total bill charge;
(o) The name and address of the practitioner
				rendering the services and the provider account number assigned by the
				department;
(p) Date of
				billing;
(q) Submission of
				supporting documentation required under subsection (6) of this
				section.