1. An itemized bill must be prepared in compliance with COMAR 14.09.03.01(6) (on a CMS 1500 form in the manner provided by the Workers’ Compensation Commission) and submitted to the Employer/Insurer for payment.
2. If payment is refused, then an itemized bill prepared in compliance with COMAR 14.09.03.01(6) must be submitted with the WCC Claim For Medical Services form C-51 including any relevant correspondence on the subject.
* Form C-51 must be completed in entirety.
* If any required information is not complete, all documents will be returned with a cover letter stating what is needed.
* Social Security Number must be provided.
* Dates of service will be checked against any/all Employee Claim Form C-1 and/or First Report of Injury filed.
* If the CMS 1500 Form is not properly prepared, the C-51 Form will be returned to the Health Care Provider and the C-51 Form will not be processed by the Workers’ Compensation Commission.
3. CPT codes will be validated using the Medical Fee Guide for the year of service. Some CPT codes which are not "specific" may require a detailed description.
4. The Commission will issue an Order NISI for allowed medical claims per the Medical Fee Guide.
* To controvert the Order NISI complete the Workers’ Compensation Commission form H-32 “Controversion of Medical Claim”.
* The “Controversion of Medical Claim” form must be filed with the Workers’ Compensation Commission within 21 days of the Order NISI and copies must be mailed to the Health Care Provider and other appropriate parties.
* If the medical claim is controverted, it will be scheduled for a hearing before a Commissioner.
5. If the medical claim is not controverted, the Workers’ Compensation Commission will issue a Final Order of Payment.
* A provider may request a hearing before the Commission if an insurer refuses payment of the Medical Claim after the Final Order of Payment.
* The Commission may impose penalties, fines and interest or may deny the Employer and Insurer the right to object to reimbursement if the Insurer fails without good cause to timely reimburse the provider for treatment or services. (LE §9-664); COMAR 14.09.03.01(6).
Note: The Medical Fee Guide referenced is the “Official Maryland Workers’ Compensation Medical Fee Schedule ”.