Section 4603.4 Of Article 2. Medical And Hospital Treatment From California Labor Code >> Division 4. >> Part 2. >> Chapter 2. >> Article 2.
4603.4
. (a) The administrative director shall adopt rules and
regulations to do all of the following:
(1) Ensure that all health care providers and facilities submit
medical bills for payment on standardized forms.
(2) Require acceptance by employers of electronic claims for
payment of medical services.
(3) Ensure confidentiality of medical information submitted on
electronic claims for payment of medical services.
(b) To the extent feasible, standards adopted pursuant to
subdivision (a) shall be consistent with existing standards under the
federal Health Insurance Portability and Accountability Act of 1996.
(c) The rules and regulations requiring employers to accept
electronic claims for payment of medical services shall be adopted on
or before January 1, 2005, and shall require all employers to accept
electronic claims for payment of medical services on or before July
1, 2006.
(d) Payment for medical treatment provided or prescribed by the
treating physician selected by the employee or designated by the
employer shall be made with an explanation of review by the employer
within 15 working days after electronic receipt of an itemized
electronic billing for services at or below the maximum fees provided
in the official medical fee schedule adopted pursuant to Section
5307.1. If the billing is contested, denied, or incomplete, payment
shall be made with an explanation of review of any uncontested
amounts within 15 working days after electronic receipt of the
billing, and payment of the balance shall be made in accordance with
Section 4603.2.