Wash. Admin. Code § 296-15-232 - Self-insurance medical bill electronic data interchange
(1) Self-insurers are required to report
medical bills incurred from their workers' compensation claims according to
department guidelines.
(a) All bills
associated with qualifying claims must be reported, and the department will
establish a minimum threshold percentage for reporting of bill to claims to
monitor compliance.
(b) Qualifying
claims include claims for which:
(i) The date
of injury (DOI) was on or after January 1, 2020.
(ii) The claim was initiated during a time
that the employer was self-insured, and the liability for that claim remains
with the employer.
(2) Self-insurers must submit complete and
accurate reports based on standards set forth by the International Association
of Industrial Accident Boards and Commissions (IAIABC).
(a) The department will systematically
monitor report data for quality and timeliness, and establish objective
performance standards based on the overall reporting of data.
(b) The department will establish a maximum
threshold percentage for errors or untimely submittals.
(c) The department will provide notification
to submitters if performance measures are below the standard set by the
department.
(d) Submitters will
have thirty days from the date of notification to make corrections to errors
and resubmit, or request an extension in writing to the department.
(e) The department will review errors that
remain uncor-rected after thirty days. Uncorrected errors may result in
training, audit, rule violation penalties, and/or a corrective action
process.
(3) New
self-insurers may apply for an exemption to reporting medical bills with their
application for certification as a self-insured employer.
(a) To qualify for the exemption, the
employer must have had one or fewer claims filed in the state of Washington in
the last three years, and the employer must have fewer than five employees in
the state.
(b) The department may
deny any request for exemption.
(c)
Authority to grant or deny exemptions belongs to the supervisor of industrial
insurance, or designee.
(d) If
granted, the exemption expires after three years. The employer may apply for
another exemption at that time.
Notes
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