La. Admin. Code tit. 40 § I-5123

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-5123 - Copies of Records and Reports

A. Health care providers must submit copies of records and reports to carriers, employers, claimants or their attorney and the Office of Workers' Compensation Administration upon request. Providers can facilitate the timely processing of claims and payment for services by submitting appropriate documentation to the carrier/self-insured employer when requested.

B. Health care providers are entitled to recover a reasonable amount, not to exceed $1 per page, to cover the cost of copying documents which have been requested by the carrier.

1. Certain procedure code descriptors require the submission of records and/or reports with the claim form. There is no reimbursement of copy charges to the provider for these required records and reports.

2. Documentation which is submitted by the provider, but was not specifically requested by the carrier, is not allowed a copy charge.

C. Health care providers must furnish an injured employee copies of his records and reports at the same time as copies are being furnished to the employer or carrier, at no expense to the employee. If additional copies are requested by claimant or his attorney, the copy charge to the employee or his attorney may not exceed $0.50 per page.

D. Health care providers may charge the actual direct cost of copying X-rays, microfilm or other nonpaper records.

E. The OWCA may charge the actual cost of reproducing records which is established at $0.25 per page and must be paid in advance.

F. A health care provider may not charge a separate fee for medical reports that are required to substantiate the medical necessity of a service.

G. CPT Code 99080 is not to be used to complete required workers' compensation forms or to complete required documentation to substantiate medical necessity. CPT Code 99080 is not to be used for signing affidavits or certifying medical records forms. CPT Code 99080 is appropriate for billing of a special report such as independent medical examination report.

La. Admin. Code tit. 40, § I-5123

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2., 1125, 1127 and 1310.12.