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§ 134.120. Reimbursement for Medical Documentation

(a) An insurance carrier is not required to reimburse initial medical documentation provided to the insurance carrier in accordance with § 133.210 of this title (relating to Medical Documentation).

(b) An insurance carrier shall separately reimburse subsequent copies of medical documentation requested by the insurance carrier in accordance with § 133.210 of this title.

(c) Upon request, the health care provider shall provide the injured employee, or the injured employee’s representative, an initial copy of the medical documentation without charge. The requestor shall reimburse the health care provider for subsequent requests of the same medical documentation.

(d) If the injured employee, or the injured employee’s representative, requests creation of medical documentation, such as a medical narrative, the requestor shall reimburse the health care provider for this additional information.

(e) The health care provider shall provide copies of any requested or required documentation to the Division at no charge.

(f) The reimbursements for medical documentation are:

(1) copies of medical documentation–$.50 per page;

(2) copies of hospital records–an initial fee of $5.00 plus $.50 per page for the first 20 pages, then $.30 per page for records over 20 pages;

(3) microfilm–$.50 per page;

(4) copies of X-ray films–$8.00 per film;

(5) narrative reports:

(A) one to two pages–$100;

(B) each page after two pages–$40 per page.

(g) Narrative reports are defined as original documents explaining the assessment, diagnosis, and plan of treatment for an injured employee written or orally transcribed and created at the written request of the insurance carrier or the Division. Narrative reports shall provide information beyond that required by prescribed medical reports and/or records. A narrative report should be single spaced on letter-size paper or equivalent electronic document format. Clinical or progress notes do not constitute a narrative report.

The provisions of this § 134.120 adopted to be effective May 2, 2006, 31 TexReg 3561.

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At a Glance:

Title:

§ 134.120. Reimbursement for Medical Documentation

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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