Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 53 - Dental Care Services, Reimbursement Schedule and Billing Instructions
Section I-5341 - Annual Maintenance

Universal Citation: LA Admin Code I-5341

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

A. To ensure that the maximum allowable reimbursement schedule is as fair as possible, the Office of Workers' Compensation will require the carriers/self-insured employers to submit the following information for claims incurred in the preceding period.

1. This information will be reviewed and any changes to the maximum allowable reimbursement rates will be published.

B. Information Required. The information required to review and establish appropriate maximum allowable reimbursement rates will include:

Information

Positions

Type

1

CDT-1 Code

5

Alpha Numeric

2

Provider Name

30

Alpha Numeric

3

Provider Street Address

30

Alpha Numeric

4

Charge Amount per Procedure

10

Numeric

5

Place of Treatment

2

Numeric

6

Date of Injury (yy/mm/dd)

6

Numeric

7

Claimant Name

30

Alpha

8

Claimant Social Security

9

Numeric

9

Employer Name

20

Alpha Numeric

10

Date of Payment of Bill (yy/mm/dd)

6

Numeric

C. Communication Format. The following is the current format, however, the Office of Workers' Compensation will establish the format on an annual basis to facilitate the review:

1. magnetic tape:
a. tape 9-tract, 8.5" to 10.5" reels with silver mylar reflector (standard reels) with write-ring removed;

b. recording density-1600 or 6250 bytes per inch;

c. recording code-extended binary coded decimal interchange code (EBCDIC);

d. header record must identify submitter and position of each field in the record;

e. tape must have a leading tape mark and an end of file mark;

f. the external label must identify the submitter, the date submitted, the tape number with identification of the total number of tapes submitted and the descriptive narrative of the information contained within the records;

2. diskettes:
a. a 5.25 inch diskette (floppy disk) that is IBM PC-DOS compatible with the following attributes:
i. double sided;

ii. double density;

iii. soft sectored;

iv. 9 sectors per track;

v. 40 tracks per diskette;

b. a 3.5 inch, 720K diskette, that is IBM PC-DOS compatible with the following attributes:
i. double sided;

ii. double density;

c. the external label must identify the submitter, the date submitted, the diskette number with identification of the total number of diskettes submitted and the descriptive narrative of the information contained within the records.

D. Maintenance Activities

1. The information submitted will be arrayed in procedure code order.

2. The information for each procedure code will be analyzed to determine the mean value of the charges submitted.

3. This revised information will be published as the update for the maximum allowable reimbursement schedule.

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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