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Just In Time: Your Guide to the SB 1175 Billing Deadline

August 21, 2017 by Catherine Montgomery

Last year, SB 1175 joined SB 1160 in a one-two punch of workers’ comp reform. Amidst the continuing brouhaha about liens and fraud prevention, we want to remind providers about the new one-year deadline for original bill submission. Applicable to both medical and medical-legal services, the new billing requirement became effective on January 1st, 2017. The timely filing requirement is not retroactive to services rendered before 1/1/2017.

SB 1175 timely filing deadlines apply to all provider of services provided pursuant to Section 4600, including, but not limited to physicians, hospitals, pharmacies, interpreters, copy services, transportation services, and home health care services.

This and other timeline requirements from the Division of Workers’ Compensation (DWC) mean that timeliness isn’t just good practice, it’s the law of the land. To be sure that providers and claims administrators are compliant, we compiled the following SB 1175 Summary:

Services

SB 1175 Section

Amended Labor Code

Requirements

  • Physicians
  • Hospitals
  • Pharmacies
  • Interpreters
  • Copy Services
  • Transportation Services
  • Home Health Care Services

SB 1175 Section 1

Labor Code §4603

Submit bills for medical services within 12 months of the date of service (DOS), for all DOS on or after January 1, 2017.


No payment is due for untimely submitted bills.

  • Medical-legal evaluations
  • Medical-legal expenses

SB 1175 Section 3

Labor Code §4625

Submit bills for medical-legal evaluation and related medical-legal services within 12 months of the date of service, for all DOS on or after January 1, 2017.


No payment is due for untimely submitted bills.

Labor Code Citations for New Provider Deadlines for Original Bills

  • Labor Code § 4603.2 [a](b)(1)(B) Effective for services provided on or after January 1, 2017, the request for payment with an itemization of services provided and the charge for each service shall be submitted to the employer within 12 months of the date of service or within 12 months of the date of discharge for inpatient facility services.  The administrative director shall adopt rules to implement the 12-month limitation period.  The rules shall define circumstances that constitute good cause for an exception to the 12-month period, including provisions to address the circumstances of a nonoccupational injury or illness later found to be a compensable injury or illness.  The request for payment is barred unless timely submitted..
  • Labor Code § 4625 (a) Effective for services provided on or after January 1, 2017, all bills for medical-legal evaluation or medical-legal expense shall be submitted to the employer within 12 months of the date of service in the manner prescribed by the administrative director.  The administrative director shall adopt rules to define circumstances that constitute good cause for an exception to the 12-month period.  Bills for medical-legal charges are barred unless timely submitted.

Should the current acting Administrative Director of the DWC adopt any further timely filing regulations pursuant to SB 1175, we will post updates. For now, DaisyBillers can use the Bill History feature to access proof of timely filing by providers, and of acceptance of bills by claims administrators.


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For another blog post:

Provider Deadlines for Medical Service Bills

Action

Required Timeline

Original Bill Submission

12 months from date of service (DOS), for all DOS on or after January 1, 2017

Request for Second Bill Review (SBR)

90 calendar days from receipt of Explanation of Review (EOR)

Request for Independent Bill Review

30 calendar days from final EOR

Lien Filing with Workers’ Compensation Appeals Board

18 months from DOS

Claims Administrator Deadlines for Medical Service Bills

Action

Required Timeline (E-Bills)

Required Timeline (Paper Bills)

Return EOR for Original Bill submitted electronically

15 working days from receipt of bill

30 calendar days from receipt of bill for contested, denied, or incomplete bill.

45 calendar days from receipt of bill for uncontested bill.

Remittance of payment for original bill

15 working days from receipt of bill.

45 calendar days from receipt of bill for non-government employer.

60 calendar days from receipt of bill for government employer.

Submit Final EOR for Second Bill Review

14 calendar days from receipt of SBR.

14 calendar days from receipt of SBR.

Remittance of payment for SBR

21 calendar days from receipt of SBR.

21 calendar days from receipt of SBR.

[a]Inserted .2 in the cite

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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

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