13378354, 69L-7.602 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 13378354

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW

Overview

RULE:

69L-7.602

Florida Workers' Compensation Medical Services Billing, Filing and Reporting Rule

PURPOSE:

The proposed rule amendment reduces regulatory burdens placed on insurers under existing provisions of the rule. In the case of medical bills for pharmaceuticals or pharmaceutical services provided by a pharmacy or pharmacist under Chapter 465, F.S., the insurer, service company/TPA or any entity acting on behalf of the insurer, would be relieved of the obligation of issuing an Explanation of Bill Review (“EOBR”) to that pharmacy or pharmacist if there is a preexisting contract between the two that governs and specifies the amount of reimbursement due on the medical bill.

SUMMARY:

The rule is amended to provide that insurers, or other entities acting on behalf of an insurer, are not required to issue an Explanation of Bill Review to pharmacists for pharmaceutical services in cases where a preexisting contract between the parties specifies the terms of reimbursement for the services provided.

RULEMAKING AUTHORITY:

440.13(4), 440.15(3)(b), (d), 440.185(5), 440.525(2), 440.591, 440.593(5) F.S.

LAW:

440.09, 440.13(2)(a), (3), (4), (6), (11), (12), (14), (16), 440.15(3)(b), (d), 440.185(5), (9), 440.525(2), 440.593 FS.

PRINT PUBLISH DATE:

8/14/2013 Vol. 39/158

COMMENTS:

From 8/14/2013 To 9/4/2013 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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