The Office of Administrative Law Has Approved DWC’s Final Versions of the Independent Medical Review
The Office of Administrative Law (OAL) approved the Independent Medical Review (IMR) and Independent Bill Review (IBR) regulations. Both sets of regulations were filed with the Secretary of State on February 12, 2014 and are effective immediately. Prior to March 1, 2014, any version of the IMR application form adopted by the Administrative Director under Section 9792.10.2 may still be used.The final IMR regulations include the following:· Revisions to the IMR application form and improved instructions. · Clarification that IMR determination cannot be based solely on information provided by a UR determination.Provisions for penalties to be assessed against a claims administrator for failure to timely produce medical records. The final IBR regulations include:· Revision to the forms used by providers to request a second bill review and IBR.· Limitations on the consolidation of separate IBR requests to 20 requests.· Required index of supporting documentation.· Updated versions of the Electronic Medical Billing and Payment Companion Guide as well as the California Division of Workers’ Compensation Medical Billing and Payment Guide.Please be sure to review the final regulations as posted on the DWC webpage, to ensure compliance with the IMR and IBR regulations.