Mandatory Billing Deadlines in SB 1175

Senate Bills 1160 and 1175 introduced sweeping reform to workers’ compensation. Here’s a rundown of SB 1175’s timely bill submission requirements.

Frequently Asked Question

Q: Do the new mandatory billing deadlines in SB 1175 apply to dates of service prior to January 1, 2017?

A: No. The new timely bill submission requirement does not apply to dates of service prior to January 1, 2017.

Explanation

Starting January 1, 2017, Senate Bill 1175 requires all providers of service and medical-legal providers to submit bills for services to the claims administrator within 12 months of rendering services or from the date of discharge from an inpatient facility.

Per the new legislation, no payment is due for untimely bill submission.

The administrative director will issue rules detailing exceptions to the 12-month period for providers of services. No exceptions will be made for medical-legal services.

SB 1175, Section 1 amends California Labor Code Section 4603 to require timely submission for all service providers and  reads as follows: 

“Effective for services provided on or after January 1, 2017, the request for payment with an itemization of services provided and the charge for each service shall be submitted to the employer within 12 months of the date of service or within 12 months of the date of discharge for inpatient facility services. The administrative director shall adopt rules to implement the 12-month limitation period. The rules shall define circumstances that constitute good cause for an exception to the 12-month period, including provisions to address the circumstances of a nonoccupational injury or illness later found to be a compensable injury or illness. The request for payment is barred unless timely submitted.”

SB 1175, Section 3 amends Labor Code 4625 to require that all medical-legal bills for dates of service on or after January 1, 2017 are also subject to 12-month timely bill submission deadlines:

“Effective for services provided on or after January 1, 2017, all bills for medical-legal evaluation or medical-legal expense shall be submitted to the employer within 12 months of the date of service in the manner prescribed by the administrative director. The administrative director shall adopt rules to define circumstances that constitute good cause for an exception to the 12-month period. Bills for medical-legal charges are barred unless timely submitted.”

Additional Information

Full text of Senate Bill 1175

DaisyBill Resources

Webinar: Senate Bills 1160 and 1175

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