|
This table provides state requirements on when providers must bill
payors, when the payors must pay the provider; what repercussions exist
for violations; and finally, how medical disputes are resolved in each
of the states. |
|
State |
Timeframe in Which Provider Must Send Bill To Payer |
Repercussion for Provider if Billing Not Sent Timely |
Timeframe from Receipt That Payer Must Pay the Provider |
Penalty for Payer if Late Payment or Unresponsive |
How is Penalty Assessed? |
Process Used To Resolve Medical Billing and Treatment Disputes |
Formal Authority To Resolve Medical Disputes |
Processes Used for Resolution of Medical Disputes |
|
Separate Process For Medical Disputes Prior to Hearing |
Use Same Process For All Litigation |
Other |
|
Sample State 1 |
None |
None |
None |
None |
None |
Yes |
|
|
The Director -Workers' Compensation Agency using trained administrative
staff |
Administrative review; informal conference; or informal hearing |
|
Sample State 2 |
None |
None |
30 days for hospital |
None |
None |
Yes |
|
|
Mediation |
Mediation, nonbinding arbitration |
|
Notes: |
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