Summary


The proposed rule chapter provides that Carriers satisfy their mandatory reporting requirements under Section 440.13(8), F.S., “Pattern or Practice of Overutilization,” by filing the required medical claims data elements and any other medical billing and payment information required by the Division in accordance with the provisions of subsections (5) and (6) of Rule 69L-7.602, F.A.C., “Florida Workers’ Compensation Medical Billing, Filing and Reporting Rule,” or denies authorization of a recommended medical benefit by issuing a Notice of Denial Form, DFS-F2-DWC-12, pursuant to Rule 69L-3.012, F.A.C. The proposed rule chapter also incorporates new form DFS-F6-DWC-2000, titled, “Health Care Provider Violation Referral Form,” that provides Carriers with a discretionary method of reporting Health Care Provider violations to augment the mandatory process that occurs in accordance with the provisions of Rule 69L-7.602, F.A.C.