Section 92-01-02-48 - Elements of filing1. For purposes of this section, unless the context otherwise requires: a. "Appropriate record" means a legible medical record or report from a provider, or any other relevant and material information, substantiating the type, nature, extent, and work-relatedness of an injury, which is adequate to verify the level, type, and extent of services provided. b. "Bill" means a provider's statement of charges and services rendered for treatment of a work-related injury. c. "Bill review" means the review or audit of medical bills and any associated medical records by workforce safety and insurance and may include review for duplications, omissions, actual delivery of billed services and items, accuracy of charges and associated coding, and improper concurrent bills for services involving evaluation or treatment of work-related and non-work-related problems. d. "Wage verification" means federal and state income tax returns; W-2 forms; daily, weekly, biweekly, semimonthly, or monthly employer payroll statements; and income statements prepared in accordance with generally accepted accounting practices. 2. The elements of filing for an application for workers' compensation benefits are satisfied when the organization has received: a. The first report of injury form completed and signed by the injured employee or someone acting on the injured employee's behalf. The employer's report may be deemed admitted pursuant to North Dakota Century Code sections 65-01-16 or 65-05-01.4; b. Wage verification as requested by the organization, if disability benefits are claimed; and c. Appropriate records from the provider necessary to determine the type, nature, extent, and potential work-relatedness of the injury or disability. 3. The elements of filing for a reapplication are satisfied when the organization is in receipt of: a. The C4 form or other correspondence requesting benefits signed by the employee;b. Wage verification as requested by the organization, if disability benefits are claimed; andc. Appropriate records from the provider.4. The elements of filing for payment of a medical bill are satisfied when a bill review is completed and after the organization has received: a. A bill from the provider or employee; and b. Appropriate records from the provider or employee. 5. If the organization requests additional information from the employee needed to process an application or a reapplication and the employee does not provide the information, elements of filing are not satisfied until the employee provides the requested information. 6. The organization may waive elements of filing in conjunction with programs established for the expedited processing of selected claims.N.D. Admin Code 92-01-02-48
Effective January 1, 1994; amended effective January 1, 1996; April 1, 1997; February 1, 1998; January 1, 2000; July 1, 2006.Amended by Administrative Rules Supplement 2016-360, April 2016, effective 4/1/2016.Amended by Administrative Rules Supplement 376, April 2020, effective 4/1/2020.Amended by Administrative Rules Supplement 2021-383, January 2022, effective 1/1/2022.General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-20, 65-05-02