4123-6-02.21 Provider access to the HPP - non-certified provider enrollment.

(A) The bureau may enroll non-certified providers eligible under rule 4123-6- 06.2 or 4123-6-10 of the Administrative Code or division (J) of section 4121.44 of the Revised Code to receive reimbursement for goods and services provided to injured workers, and for this purpose may require such non-certified providers to complete and sign an enrollment application and agreement as the bureau deems appropriate, provided such non-certified providers meet the minimum qualifications for their provider category as set forth in paragraph (C) of rule 4123-6-02.2 of the Administrative Code.

(B) Persons or entities who do not fall within the provider categories set forth in paragraph (C) of rule 4123-6-02.2 of the Administrative Code are not eligible for certification as providers. The bureau may enroll such persons or entities to receive reimbursement for goods and services provided to injured workers, and for this purpose may require such persons or entities to complete and sign an enrollment application and agreement as the bureau deems appropriate.

(C) The certification of persons or entities certified as providers prior to the effective date of this rule who do not fall within the provider categories set forth in paragraph (C) of rule 4123-6-02.2 of the Administrative Code shall expire on a schedule determined by the bureau, and such persons or entities shall not be eligible for recertification as providers.

(D) The enrollment of a non-certified provider, person, or entity pursuant to paragraph (A) or (B) of this rule shall expire, on a schedule determined by the bureau, if the non-certified provider, person, or entity has had no billing activity with the bureau for a period of two years or longer.

(E)Expiration of provider certification or enrollment pursuant to paragraph (C) or (D) of this rule does not constitute an adjudication order and is not subject to appeal pursuant to rule 4123-6-17 of the Administrative Code.

Effective: 02/01/2010
R.C. 119.032 review dates:11/17/2009 and 02/01/2015
Promulgated Under: 119.03
Statutory Authority: 4121.12 , 4121.121 , 4121.30 , 4121.31 , 4123.05
Rule Amplifies: 4121.121 , 4121.44 , 4121.441 , 4123.66
Prior Effective Dates:4/1/07