Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 51 - Medical Reimbursement Schedule
Section I-5107 - Other Payer Liabilities

Universal Citation: LA Admin Code I-5107

Current through Register Vol. 50, No. 9, September 20, 2024

A. Whenever a claimant is eligible for Medicare or payment from another third party payer and is also eligible for workers' compensation medical benefits, the carrier/self-insured employer is always the primary payer, the payer of first resort. Services related to compensable conditions should be billed to the carrier/self-insured employer before attempting to collect from the third party payer.

B. If a claimant is receiving treatment for both compensable and noncompensable medical conditions, only those services provided in treatment of compensable conditions should be listed on claims and invoices submitted to the carrier/self-insured employer. In addition, payments from private payers for noncompensable conditions should not be listed on invoices submitted to the carrier/self-insured employer.

C. Charges for noncompensable conditions are collectible by the provider from any other third party payer, subject to the limitations and exclusions contained in the third payer's policy.

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.

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