Section 4603.3 Of Article 2. Medical And Hospital Treatment From California Labor Code >> Division 4. >> Part 2. >> Chapter 2. >> Article 2.
4603.3
. (a) Upon payment, adjustment, or denial of a complete or
incomplete itemization of medical services, an employer shall provide
an explanation of review in the manner prescribed by the
administrative director that shall include all of the following:
(1) A statement of the items or procedures billed and the amounts
requested by the provider to be paid.
(2) The amount paid.
(3) The basis for any adjustment, change, or denial of the item or
procedure billed.
(4) The additional information required to make a decision for an
incomplete itemization.
(5) If a denial of payment is for some reason other than a fee
dispute, the reason for the denial.
(6) Information on whom to contact on behalf of the employer if a
dispute arises over the payment of the billing. The explanation of
review shall inform the medical provider of the time limit to raise
any objection regarding the items or procedures paid or disputed and
how to obtain an independent review of the medical bill pursuant to
Section 4603.6.
(b) The administrative director may adopt regulations requiring
the use of electronic explanations of review.