Ohio Admin. Code 4123-3-23 - Limitations on the filing of fee bills
(A) Except as otherwise provided in this
rule, fee bills for medical or vocational rehabilitation services rendered in a
claim shall be submitted to the bureau or commission for payment within one
year of the date on which the service was rendered or one year after the date
the services became payable under division (I) of section
4123.511
of the Revised Code, whichever is later, or shall be forever barred.
(B) A self-insuring employer may, but is not
required to, negotiate with a provider to accept fee bills from the provider
for a time period other than as set forth in paragraph (A) of this
rule.
(C) Paragraph (A) of this
rule shall not apply to the following:
(3)(4) Fee bills submitted
outside the timeframe set forth in paragraph (A) of this rule due to MCO or
bureau error; however, division (A) of section
4123.52
of the Revised Code shall still apply;
(4)(5) Fee bills submitted
outside the timeframe set forth in paragraph (A) of this rule because the fee
bills were initially submitted to a patient, different third-party payer, or
state or federal program other than medicare,
or medicaid, or the
VA that reimburses for medical or vocational rehabilitation services and
that patient, payer, or program has determined that it is not responsible for
the cost of the services; however, division (A) of section
4123.52
of the Revised Code shall still apply.
(1)
Requests made by the centers for medicare and medicaid services in the United
States department of health and human services for reimbursement of conditional
payments made pursuant to section 1395y(b)(2) of title 42, United States Code
(commonly known as the "Medicare Secondary Payer Act")
as in effect on the date of the
request;
(2) Requests made
by the Ohio department of medicaid, or by a medical assistance provider to whom
the department has assigned its right of recovery for a claim for which it has
notified the provider that it intends to recoup its prior payment for a claim,
for reimbursement under sections
5160.35
to
5160.43
of the Revised Code for the cost of medical assistance paid on behalf of a
medicaid recipient;
(3)
Requests made by the department of veterans affairs
(VA) pursuant to section 1729 of title 38, United States Code for reimbursement
of medical treatment provided to an injured worker in or through any VA
provider or facility;
(D) Except in cases involving MCO or bureau
error, requests for additional payment on fee bills that were initially timely
submitted under this rule shall be submitted within one year and seven days of
the adjudication of the initial fee bill by the bureau or shall be forever
barred. No medical or vocational rehabilitation provider shall bill a claimant
for any request for additional payment that is barred under this
paragraph.
(E) Paragraphs (A) to
(C) of this rule shall apply to bills with dates of service on or after July
29, 2011. Paragraph (D) of this rule shall apply to bills with dates of service
on or after September 12, 2011.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.13, 4121.30, 4121.31, 4123.52
Rule Amplifies: 4121.121, 4123.66
Prior Effective Dates: 01/01/1964, 01/09/1967, 01/16/1978, 09/12/2011, 07/27/2015
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