Ohio Admin. Code 4123-3-36 - Immediate allowance and payment of medical bills in claims
(A) In accordance
with division (A) of section
4123.511 of the Revised Code the
administrator has established a program to immediately allow specific medical
conditions which have a historical record of being allowed whenever included in
a claim and having low medical costs.
The medical conditions that
the administrator has determined to be included in the program are indicated in
the appendix to this rule.
(B) Upon the initial filing of a claim, the
administrator shall
will investigate the claim and issue an order on the
claim as required by
pursuant to section
4123.511 of the Revised Code.
The administrator shall consider all of the
necessary evidence and relevant laws and rules for the determination of the
allowance of a claim. For any medical condition identified in
the appendix A to this rule, however, the administrator may
grant immediate allowance of the medical condition and may make immediate
payment of the medical bills relating to that condition, regardless of the
receipt of the medical reports for that medical condition or the employer's
certification of the claim.
(C) The
employer retains the right to contest the immediate allowance
and payment of a medical condition in a
claim under this rule. If the employer appeals the allowance
and payment and the claim is disallowed,
the payment for the medical treatment provided prior to the date of the
disallowance of that claim shall be charged to and paid from the surplus fund
created under section
4123.34 of the Revised Code. The
administrator shall
will not seek reimbursement of the payment from the
claimant or the provider.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4123.511
Prior Effective Dates: 12/17/2001, 02/10/2009, 04/01/2014, 10/01/2015, 07/01/2019
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