DWC Issues 15-day Notice for Modifications to Proposed Independent Bill Review

DWC Issues 15-day Notice for Modifications to Proposed Independent Bill Review, Standardized Paper Billing and Payment, and Electronic Billing and Payment Regulations.

A 15-day notice of modification to the proposed Independent Bill Review (IBR), Standardized Paper Billing and Payment, and Electronic Billing and Payment regulations has been distributed to interested parties and posted to the DWC website. The public is invited to send comments regarding the proposed modifications to dwcrules@dir.ca.gov until 5 p.m. on October 23. The proposed modifications include:

· Revised forms for providers to request a second bill review and IBR

· Expressly allowing IBR for a bill involving one hospital stay

· Conditions for determining IBR eligibility whether the second request for review of the bill was timely requested by the provider and whether the second review of the bill was timely completed by the claims administrator

· Requiring a provider requesting IBR to index all supporting documentation

· Expressly allowing the claims administrator to submit documentation challenging both the eligibility of an IBR request and the provider’s reason for requesting IBR

· Allowing providers to withdraw their IBR request with the reimbursement of $270 from the IBR filing fee provided the withdrawal is made prior to the assignment of the request to the Independent Bill Review Organization for determination of the dispute

· Revision of the documentation requirements for pharmacy bills to eliminate the requirement to submit a prescription at the time the bill is submitted

· Adoption of the International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) and the International Classification of Diseases 10th Revision Procedure Coding System (ICD-10-PCS) effective for services/hospital discharges on or after October 1, 2014 (the same date as required under HIPAA)

· Adoption of the new CMS 1500 Claim Form (02/2012) and the American Dental Association Dental Claim Form (2012)

· Streamlining procedure to identify the documents to support an electronic medical bill.

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