This article outlines Idaho’s workers’ compensation billing forms and reporting requirements.
Billing Form Requirements
This table is a guide to the required forms for compliant paper and electronic workers’ comp billing in Idaho.
Forms |
Services |
CMS-1500 |
Physician Services Pathology / Laboratory Outpatient Services |
UB-04 |
Facility – Inpatient |
Not Specified |
Pharmacy |
Not Specified |
Dental |
Provider Reporting Requirements
Service |
Document Description |
Number of Days until Due |
Form Link |
Treatment |
Medical Report |
14 days |
No specific form |
IDAPA 17.01.01.404 - Submission of Medical Reports from Providers
01. Procedure. In all cases in which a particular injury or occupational disease results in a worker's compensation Claim, the Provider shall submit written Medical Reports for each medical visit to the Payor.
A medical authorization for release of records signed by Claimant shall remain in effect until revoked.
Payors and Providers may contract with one another to identify specific records that will be provided in support of billings.
The Provider shall also submit the same written Medical Reports to the Claimant upon request. These reports shall be submitted within fourteen (14) days following each evaluation, examination, and/or treatment. The first copy of any such reports shall be provided to the Payor and the Claimant, or their attorney, at no charge. If duplicate copies of reports already provided are requested by either the Payor or the Claimant, the Provider may charge the requesting party a reasonable charge to provide the additional reports. Whenever possible, billing information shall be coded using CPT.
In the case of Hospitals, reports shall include a Uniform Billing Form 04. In the case of physicians and other Providers supplying outpatient services, this reporting requirement shall include a CMS 1500 form.
a. If an injury or occupational disease results in a Claim, the Employer/Surety or Provider shall submit written reports to the Commission upon request. Such request may either be in writing or telephonic.
If a Claim is referred to the Rehabilitation Division, Medical Reports shall be furnished by the Payor or Provider directly to the office that requests such reports. The Payor or Provider shall consider this an on-going request until notice is received that the reports are no longer required.
b. If the injury or occupational disease results in a time-loss Claim, the Payor shall submit copies of medical records containing information regarding the beginning and ending of disability, releases to work whether light duty or regular duty, impairment ratings, physical restrictions to the Commission. Other Medical Reports shall be submitted to the Commission only upon request.
02. Report Form and Content. Upon approval of the Commission, Medical Reports may be submitted in electronic or other machine-readable form usable to all parties.
03. Timely Response Requirement. When the Commission requests a Medical Report from a Payor or Provider for use in monitoring a worker's compensation Claim, the Payor or Provider shall provide the requested information promptly.
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