Published on: 13378354. The proposed rule amendment reduces regulatory burdens placed on insurers under existing provisions of the rule. In the case of medical bills for pharmaceuticals or pharmaceutical services provided by a pharmacy or pharmacist under Chapter 465, F.S., the insurer, service company/TPA or any entity acting on behalf of the insurer, would be relieved of the obligation of issuing an Explanation of Bill Review (“EOBR”) to that pharmacy or pharmacist if there is a preexisting contract between the two that governs and specifies the amount of reimbursement due on the medical bill.
Published on: 13266998. To develop amendments to Rules 69L-7.020 and 69L-7.602, F.A.C., that take into account amendments to paragraphs 440.13(12)(c) and (d), F.S., enacted through Chapter 2013-131, Laws of Florida.
Published on: 13031870. The proposed rule reduces regulatory burdens placed on insurers under existing provisions of the rule. In the case of medical bills for pharmaceuticals or pharmaceutical services provided by a pharmacist licensed under Chapter 465, F.S., insurers would be relieved of the obligation of issuing an Explanation of Bill Review to that pharmacy or pharmacist if there is a contract between the two that governs and specifies the amount of reimbursement due on the medical bill.
Published on: 12151789. Variance or Waiver from Petitioner, Health E Systems, LLC. The Petition has been assigned the number 129147. Petitioner seeks a variance of paragraphs 69L-7.602(5)(o),(q), Florida Administrative Code, which provides the insurers filing electronically with the Division of Workers’ Compensation must provide an Explanation of Bill Review codes and code descriptors relating to the adjudication of each line item billed.
Published on: 11695016. The proposed rule (which applies to dates of injury occurring on or after October 1, 2003) clarifies that an insurer must provide health care providers with prior notification of a decision to apply apportionment in the payment of reimbursement for medical services. The amendment provides that an insurer shall, at the time of authorization or, if the decision to apportion the reimbursement is made after authorization, but prior to the rendering of services, provide each health care provider with written or electronic notification of its decision to apply apportionment in the payment of reimbursement for medical service(s). The proposed rule also deletes subsection (7) of the rule which addresses administrative penalties and fines for untimely payments to health care providers or the disposition of other medical bills. These penalty provisions are transferred to Rule Chapter 69L-24, F.A.C.
Published on: 10938707. The proposed rule (which applies to dates of injury occurring on or after October 1, 2003) clarifies that an insurer must provide health care providers with prior notification of a decision to apply apportionment in the payment of reimbursement for medical services. The amendment provides that an insurer shall, at the time of authorization or following authorization but prior to the rendering of medical service(s), provide each health care provider with written or electronic notification of its decision to apply apportionment in the payment of reimbursement for medical service(s). Subsection (7) of the rule is deleted, as the penalty provisions are transferred to Rule Chapter 69L-24, F.A.C.
Published on: 10270668. Variance or Waiver from Petitioner, StrataCare, LLC. The Petition has been assigned the number 119095. Petitioner seeks a variance of paragraphs 69L-7.602(5)(o), (q), Florida Administrative Code, which provides that insurers filing electronically with the Division of Workers’ Compensation must provide an Explanation of Bill Review codes and code descriptors relating to the adjudication of each line item billed.