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Compliance Connection
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October Compliance Updates
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Welcome to the refreshed Enlyte Compliance Connection newsletter: the same content you love, from the experts you know and trust from Mitchell, Genex and Coventry. Here are the top updates for workers' comp and auto casualty for the month of October.
- Michigan
- New York
- Additional Workers' Comp Updates
- Additional Auto Casualty Update
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AUTO FIRST PARTY
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Bulletin 2020-33-INS Documentation Required for PIP Coverage Exclusion
The DIFS reminded insurers that documentation of qualified health coverage (QHC) must be collected at issuance of a new policy or at policy renewal from policyholders who opt out of purchasing PIP coverage.
READ MORE >
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AUTO FIRST PARTY
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Timely Payment of PIP Benefits Bulletin 2021-35-INS
Bulletin 2021-35-INS addresses delays in receiving payment based on incorrect coding on submitted bills by encouraging providers and insurers to engage in dialogue and work to assist with understanding the insurer's bill review, as well as expedite resubmitting services with corrected coding.
READ MORE >
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AUTO FIRST PARTY
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Update to "Hospitals with Indigent Volume Eligible for Enhanced Auto Insurance Reimbursement"
DIFS Bulletin 2021-34-INS issued on September 20, 2021 advises parties of an addition to the "Hospitals with Indigent Volume Entitled to Enhanced Auto Insurance Reimbursement" list. One hospital is added to the list of eligible facilities. This update is retroactive for all dates of service beginning July 2, 2021.
READ MORE >
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AUTO FIRST PARTY
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'Applicability of MCL 500.3157' DIFS Bulletin 2021-38-INS
Bulletin 2021-38-INS states that the "fee schedule" established under MCL 500.3157 applies to attendant care and that MCL 500.3107(1)(a) establishes rules for payment of products, services and accommodations not provided by physicians, hospitals, clinics or other like persons. It also instructs insurers to reprocess bills where products, services, etc. mentioned above may have been processed under the fee schedule rules of MCL 500.3157.
READ MORE >
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AUTO FIRST PARTY
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No-Fault Billing Disputes - DIFS Bulletin 2021-36-INS
Bulletin 2021-36-INS is issued to remind insurers that payments are due to providers upon reasonable proof of loss, and addresses three common situations:
- Not using insurer's preferred billing format
- Provider has not submitted adequate document for insurer to calculate reimbursement
- Insurer and provider disagree that claims have been billed using appropriate coding
READ MORE >
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AUTO FIRST PARTY AND WORKERS' COMPENSATION
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CMS-1500 Reminder
New York posted a notice regarding payer requirements and effective dates for the CMS-1500 initiative. The notice reminds payers that it is mandatory to accept electronic bills from providers; however, providers still have the option to send the bill electronically or by paper. On July 1, 2022, the CMS-1500 will be required for use by providers, along with the CARC/RARC codes used for objections to medical payments by payers. Please note, pharmacy bills are not included in the CMS-1500 initiative.
READ MORE >
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AUTO FIRST PARTY AND WORKERS' COMPENSATION
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Auto Emergency Codes Oct 2021
New York posted an emergency adoption of the Telemedicine codes for use in certain circumstances. The effective date was October 12, 2021, and will be effective for 90 days.
READ MORE >
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WORKERS' COMPENSATION
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Adopted Disputes Rules 2021
New York posted the adopted amendments to the Medical Billing Dispute rule, effective November 1, 2021.
READ MORE >
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WORKERS' COMPENSATION
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Proposed: Three New Medical Treatment Guidelines
The New York State Workers' Compensation Board proposed an amendment to incorporate three new Medical Treatment Guidelines: Eye Disorders, Traumatic Brain Injury, and Complex Regional Pain Syndrome. The notice was published in the State Register on October 13, 2021.
READ MORE >
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Additional Workers' Comp Updates
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CALIFORNIA
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Med/Legal Extension To 2022
California posted notice of an extension to emergency regulations regarding COVID Medical-Legal Evaluations and Reporting. The extension will make these emergency rules effective until January 11, 2022.
READ MORE >
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COLORADO
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Proposed Amendments to Medical Treatment Guidelines
The Colorado Division of Workers' Compensation proposed amendments to the Rules of Procedure with Treatment Guidelines, including Low Back Pain and Cervical Spine Injury Medical Treatment Guidelines. The Division will hold a rulemaking hearing on November 17, 2021.
READ MORE >
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FLORIDA
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Proposed 69L-7.020 July 2022
Florida posted an updated change to 69L-7.020 Health Care Provider Reimbursement Manual, to update the effective date from July 1, 2021, to July 1, 2022.
READ MORE >
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MAINE
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Fee Schedule Adoption October 1, 2021
Maine posted the adopted inpatient fee schedule and medical fee schedule rules.
READ MORE >
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MINNESOTA
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Reversed Medical Marijuana Reimbursement Requirement
The Minnesota Supreme Court reviewed and reversed two rulings by the Workers' Compensation Court of Appeals (WCCA) requiring insurers to reimburse injured employees for medical marijuana. The opinions were published October 13, 2021.
BIERBACH v DIGGER'S POLARIS >
MUSTA v MENDOTA HEIGHTS DENTAL CENTER >
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VIRGINIA
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Medical eNews 4th Quarter 2021
Virginia posted its 4th quarter Medical Fee Services eNews. This newsletter answers provider and payer concerns and questions, provides a regulatory update and addresses coding conventions for "BR" vs. unlisted procedures.
READ MORE >
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Additional Auto Casualty Update
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UTAH
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Proposed Amendments to Rules on Conversion Factors
Amendments pertaining to the PIP RVU Study have been proposed by the Utah Department of Insurance (DOI). The rule would provide conversion factors for treatment rendered on or after Jan. 1, 2022. The amendments would also remove factors to be used through 2019.
READ MORE >
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