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24.29.1406    FACILITY BILLS

(1) Facility bills must be submitted on a UB04 when the injured worker is discharged from the facility or every 30 days.

(2) The providers and payers shall use, when possible, electronic billing for the billing and reimbursement process in order to facilitate rapid transmission of data, lessen the opportunity for errors, and lessen system costs.

(3) It is the responsibility of the facility to use the proper service codes on any bills submitted for payment. The failure of a provider to do so, however, does not relieve the insurer's obligation to pay the bill, but it may justify delays in payment until proper coding of the services provided is received by the insurer.

(4) Except as provided in (3), insurers must make timely payments of facility bills. In cases where there is no dispute over liability for the condition, the insurer must, within 30 days of receipt of a facility's charges, pay the charges according to the rates established by these rules.

(5) Insurer-initiated medical necessity review, bill audits, and other administrative review procedures may only be conducted on a post-payment basis.

History: 39-71-203, MCA; IMP, 39-71-105, 39-71-107, 39-71-203, 39-71-704, MCA; Eff. 12/31/72; AMD, 2008 MAR p. 2490, Eff. 12/1/08; AMD, 2011 MAR p. 1137, Eff. 6/24/11; AMD, 2013 MAR p. 1185, Eff 7/12/13.

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