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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 5.5.0. RULES For Medical Treatment Billing and Payment on or After October 15, 2011

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§9792.5.2. Standardized Medical Treatment Billing Forms/Formats, Billing Rules, Requirements for Completing and Submitting Form CMS 1500, Form CMS 1450 (or UB-04), American Dental Association Form, Version 2006, NCPDP Workers' Compensation / Property & Casualty Universal Claim Form, Payment Requirements.


(a) The California Division of Workers' Compensation Medical Billing and Payment Guide, dated 2011, which sets forth billing, payment and coding
(a) On and after October 15, 2011, all paper bills for medical treatment provided by health care providers and health care facilities shall be submitted on billing forms set forth in the California Division of Workers' Compensation Medical Billing and Payment Guide.

(b) On and after October 15, 2011, all medical bills shall conform to the provisions of the California Division of Workers' Compensation Medical Billing and Payment Guide which includes coding, billing standards, timeframes and other rules.

(c) On and after October 18, 2012, all bills for medical treatment provided by health care providers and health care facilities may be electronically submitted to the claims administrator for payment. Electronic bills submitted on or after that date shall conform to the applicable provisions of the California Division of Workers' Compensation Medical Billing and Payment Guideand theCalifornia Division of Workers' Compensation Electronic Medical Billing and Payment Companion Guide.

(d) Except as otherwise specifically provided, legally authorized billing agents and assignees shall submit bills in the same manner as the original rendering provider or facility would be required to do had the bills been submitted by the provider or facility directly and shall conform to applicable provisions of the California Division of Workers' Compensation Medical Billing and Payment Guideand theCalifornia Division of Workers' Compensation Medical Billing and Payment Companion Guide.

Note: Authority cited: Sections 133, 4603.4, 4603.5 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2 and 4603.4, Labor Code.

HISTORY

1. New section filed 4-18-2011; operative 4-18-2011 pursuant to Government Code section 11343.4 (Register 2011, No. 16).

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