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(1) When a treating physician, emergency room or similar urgent care facility sees the claimant for the first time (related to the claim), the provider must furnish to the insurer the initial report, the Medical Status Form (MSF), and the treatment bill (CMS 1500) within seven business days of the visit.

(2) As soon as possible, upon completion of the initial diagnostic process, the treating physician must prepare a treatment plan and promptly furnish a copy to the insurer. Subsequent changes in the treatment plan must be documented and a copy of the amended treatment plan must be promptly furnished to the insurer.

(3) To be eligible for payment for subsequent visits, the provider must furnish to the insurer:

(a) the treatment bill (CMS 1500);

(b) improvement status with respect to the treatment plan; and

(c) applicable treatment notes with the bill.

(4) Certain treatment plans may require services be obtained from a vendor that is outside the tradition of being a professional health care provider. Under that circumstance, the treating physician has the obligation to include the medical necessity for the service in the treatment plan and furnish functional improvement status as appropriate. The vendor, however, is responsible for furnishing documentation.

(a) The following are examples of services that are contemplated as falling within the meaning of this subsection:

(i) health club membership; and

(ii) home health care services.

(5) Documentation is considered to be a service to the injured worker and no charge is allowed for the documentation required by this rule.

(6) The treating physician must report immediately to the insurer the date total disability ends or the date the injured worker is released to return to work.

History: 39-71-203, MCA; IMP, 39-71-704, MCA; NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1994 MAR p. 680, Eff. 4/1/94; AMD, 2013 MAR p. 1185, Eff. 7/12/13.

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