C.M.R. 90, 351, ch. 5, § 351-5-1, subsec. 351-5-1-06

Current through 2024-44, October 30, 2024
Subsection 351-5-1-06 - BILLING PROCEDURES
1. Bills must specify the billing entity's tax identification number; the license number, registration number, certificate number, or National Provider Identifier of the health care provider; the employer; the employee; the date of injury/occurrence; the date of service; the work-related injury or disease treated; the appropriate procedure code(s) for the work-related injury or disease treated; and the charges for each procedure code. Bills properly submitted on standardized claim forms prescribed by the Centers for Medicare & Medicaid are sufficient to comply with this requirement. Uncoded bills may be returned for coding.
2. Bills for insured employers must be submitted directly to the insurer of record on the date of injury/illness. Health care providers shall attempt to verify the name of the insurer that wrote the workers' compensation policy for the specific employer on the date of injury/illness prior to the submission of a bill to an insurer.
3. In the event a patient fails to keep a scheduled appointment, health care providers are not to bill for any services that would have been provided nor will there be any reimbursement for such scheduled services.
4. A bill must be accompanied by health care records to substantiate the services rendered. Fees for copies of health care records are outlined below.

C.M.R. 90, 351, ch. 5, § 351-5-1, subsec. 351-5-1-06