Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 51 - Medical Reimbursement Schedule
Section I-5105 - Verification of Coverage
Universal Citation: LA Admin Code I-5105
Current through Register Vol. 50, No. 9, September 20, 2024
A. The carrier/self-insured employer is responsible for 100 percent of the maximum allowable reimbursement rate for covered services rendered for treatment of compensable conditions. The claimant is not required to contribute a co-payment and does not have to meet any deductibles.
1.
Prior to the provision of medical services, supplies, or other non-medical
services the determination that the illness, injury, or condition, is work
related must be made, and must be accomplished in the following manner:
a. carrier/self-insured employer should be
contacted for verification of coverage/liability;
b. the name and title of the individual
verifying coverage/liability must be recorded in the claimant's
records;
c. denial of
coverage/liability must be immediately communicated to the claimant.
2. Those procedures identified in
this reimbursement schedule as noncovered are not billable to the claimant if
rendered in treatment of compensable conditions unless the claimant is informed
beforehand that he will be responsible for the charges.
3. In certain circumstances, the provider
collects his fees from the claimant because he is unsure or unaware of the
occupational nature of the injury or condition. If the provider decides to bill
the workers' compensation carrier/self-insured employer after compensability
has been established, he must, to the best of his knowledge, make certain that
the claimant has not already filed for reimbursement. If the claimant has not
filed, the provider should bill the carrier/self-insured employer and reimburse
the claimant. To avoid duplicate billings, the provider should file for the
claimant, billing the full amount; or, the claimant should bill the full amount
himself.
B. For covered services, if there is a difference between the provider's billed amount and the Office of Workers' Compensation maximum allowable reimbursement, the claimant, employer and carrier cannot under any circumstances, be billed for the difference.
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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