4123-3-23 Limitations on the filing of fee bills.

(A) Except as otherwise provided in this rule, fee bills for medical or vocational rehabilitation services rendered in a claim shall be submitted to the bureau or commission for payment within one year of the date on which the service was rendered or one year after the date the services became payable under division (I) of section 4123.511 of the Revised Code, whichever is later, or shall be forever barred.

(B) A self-insuring employer may, but is not required to, negotiate with a provider to accept fee bills from the provider for a time period other than as set forth in paragraph (A) of this rule.

(C) Paragraph (A) of this rule shall not apply to the following; however, division (A) of section 4123.52 of the Revised Code shall still apply:

(1) Requests made by the centers for medicare and medicaid services in the United States department of health and human services for reimbursement of conditional payments made pursuant to section 1395y(b)(2) of title 42, United States Code (commonly known as the "Medicare Secondary Payer Act");

(2) Fee bills submitted outside the timeframe set forth in paragraph (A) of this rule due to administrative error by the MCO or the bureau;

(3) Fee bills submitted outside the timeframe set forth in paragraph (A) of this rule because the fee bills were initially submitted to a patient, different third-party payer, or state or federal program that reimburses for medical or vocational rehabilitation services and that patient, payer, or program has determined that it is not responsible for the cost of the services.

(D) Requests for additional payment on fee bills that were initially timely submitted under this rule shall be submitted within one year and seven days of the adjudication of the initial fee bill by the bureau or shall be forever barred.

(E) Paragraphs (A) to (C) of this rule shall apply to bills with dates of service on or after July 29, 2011. Paragraph (D) of this rule shall apply to bills with dates of service on or after September 12, 2011.

Replaces: Replacing 4123-3-23

R.C. 119.032 review dates: 01/07/2014 and 01/01/2019
Promulgated Under: 119.03
Statutory Authority: 4121.12 , 4121.121 , 4121.30 , 4121.31
Rule Amplifies: 4121.121 , 4123.66
Prior Effective Dates: 1/1/64, 1/9/67, 1/16/78, 9/12/11