When does the 30-day timely billing requirement take effect, and which specific services are subject to this requirement?

Senate Bill 1160 introduced sweeping reform to workers’ compensation. Here’s a close look at the 30-day timely billing requirement for some services.

Frequently Asked Question

Q: When does the 30-day timely billing requirement take effect, and which specific services are subject to this requirement?

A: The 30-day billing requirement becomes effective January 1st, 2018. This 30-day billing requirement only applies to services where treatment is authorized without prospective utilization review.  

Explanation

Here are the six required conditions for authorization without prospective UR:

1. Dates of injury as of January 1, 2018

2. Within 30 days of initial injury

3. Body part or conditional accepted as compensable

4. Treatment included in MTUS

5. Treatment provided by an MPN or predesignated physician

6. Treatment is not excluded per subdivision (c):

  • Pharmaceuticals
  • Non-emergency inpatient / outpatient surgery
  • Psychological treatment
  • Home health care
  • Imaging and radiology services, excluding x-ray
  • Electrodiagnostic medicine
  • Any other services designated by Administrative Director

Additional Information

Full text of SB 1160

DaisyBill Resources

Webinar: Senate Bills 1160 and 1175

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