9953575, 69L-34.001 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 9953575

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

Carrier Report of Health Care Provider Violations

Overview

RULE:

69L-34.001	Definitions
69L-34.002	Mandatory Carrier Reporting
69L-34.003	Elective Referral of Alleged Health Care Provider Violation
69L-34.004	Timeliness of a Referral
69L-34.005	Referral Investigation
69L-34.006	Invalid Referrals

PURPOSE:

The purpose and effect of this proposed rule is to:
1. Clarify that the mandatory reporting of all instances of overutilization to the Division of Workers’ Compensation (“Division”) shall be accomplished by means of the Carrier’s compliance with the Division’s medical claims information filing requirements in subsections 69L-7.602(5) and (6), Florida Administrative Code (F.A.C.), Florida Workers’ Compensation Medical Services Billing, Reporting and Filing Rule; and
2. Introduce an elective reporting process by which any person may report to the Division, a Health Care Provider’s violation of Chapter 440, Florida Statutes (F.S.), and applicable administrative rules.

SUMMARY:

The proposed rule chapter provides that Carriers satisfy their mandatory reporting requirements under Section 440.13(8), F.S., “Pattern or Practice of Overutilization,” by filing the required medical claims data elements and any other medical billing and payment information required by the Division in accordance with the provisions of subsections (5) and (6) of Rule 69L-7.602, F.A.C., “Florida Workers’ Compensation Medical Billing, Filing and Reporting Rule,” or denies authorization of a recommended medical benefit by issuing a Notice of Denial Form, DFS-F2-DWC-12, pursuant to Rule 69L-3.012, F.A.C. The proposed rule chapter also incorporates new form DFS-F6-DWC-2000, titled, “Health Care Provider Violation Referral Form,” that provides Carriers with a discretionary method of reporting Health Care Provider violations to augment the mandatory process that occurs in accordance with the provisions of Rule 69L-7.602, F.A.C.

RULEMAKING AUTHORITY:

440.13(4)(c), (7)(e), 440.591 FS.

LAW:

440.13, 440.13(1), 440.13(1)(k), (4), (7), (8), (11), (13), (14), (16), 440.192 FS.

PRINT PUBLISH DATE:

5/27/2011 Vol. 37/21

COMMENTS:

From 5/27/2011 To 6/17/2011 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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