Labor Code 4603.4 and Electronic Billing

It’s a Labor Code near and dear to our hearts – 4603.4 sets down the mandate that employers must accept electronic billing for workers’ compensation bills.

Frequently Asked Question

Q: Do California Claims Administrators have to accept electronic billing for workers’ compensation?

A: Yes. Yes. Absolutely, yes. This was mandated by Senate Bill 863 way back in 2012.

Explanation

California Labor Code 4603.4 mandates employers must accept electronic submission of medical treatment bills from workers’ compensation medical providers.

Effective October 18, 2012 the Division of Workers’ Compensation Medical Billing and Payment Guide and Electronic Medical Billing and Payment Companion Guide requires claims administrators to adhere to the guides’ electronic billing requirements. According to the guides, claims administrators must:  

  1. Accept electronic bills from medical providers
  2. Return acknowledgements of receipt of electronic bills within two business days of receipt of electronically submitted bills, and
  3. Return electronic explanations of review (EORs) within fifteen working days of receipt of electronically submitted bills.

Electronic billing regulations apply to medical treatment (CMS 1500), pharmacy (NCPDP), institutional (UB04) and dental bills.

For electronically submitted bills with itemized services charged at or below the maximum amount allowed by the official medical fee schedule, Labor Code 4603.4 requires employers to remit payments within 15 working days of receipt of the electronically submitted bills.

Additional Information

California Labor Code Section 4603.4

Division of Workers’ Compensation Medical Billing and Payment Guide

Division of Workers’ Compensation Electronic Medical Billing and Payment Companion Guide

Division of Workers’ Compensation e-Billing Website

Division of Workers’ Compensation e-Billing FAQs

DaisyBill Resources

Webinar: e-Billing for Workers’ Compensation

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