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(1) After mediation, disputes between an insurer and a medical service provider arising over the amount of a fee for medical services are resolved by a hearing before the department upon written application of a party to the dispute or the injured worker. The following issues are considered to be disputes arising over the amount of a fee for medical services:

(a) amounts payable to medical providers, when benefits available directly to claimants are not an issue;

(b) access to medical records;

(c) timeliness of payments to medical providers; or

(d) requirements for documentation submitted by a provider to an insurer pursuant to ARM 24.29.1513 as a condition of the payment of medical fees.

(2) All other disputes arising over medical claims, including travel expense reimbursement to injured workers, shall be brought before a department mediator as provided in part 24 of the Workers' Compensation Act.

(3) Facility records must be furnished to the insurer upon request. Facilities must obtain the necessary release by their administrative procedures.

(4) The rule of privileged communication is waived by the injured worker seeking benefits under the Workers' Compensation or Occupational Disease acts.

History: 39-71-203, MCA; IMP, 39-71-203, 39-71-704, MCA; Eff. 12/31/72; AMD, 1991 MAR p. 2622, Eff. 12/27/91; AMD, 2007 MAR p. 260, Eff. 2/23/07; AMD, 2007 MAR p. 1670, Eff. 10/26/07; AMD, 2008 MAR p. 2490, Eff. 12/1/08.

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