R. 69L-7.020 Florida Workers’ Compensation Health Care Provider Reimbursement Manual
R. 69L-7.100 Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)
R. 69L-7.501 Florida Workers’ Compensation Reimbursement Manual for Hospitals
R. 69L-7.601 Copying Charges for Medical Records
R. 69L-7.602 Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule
R. 69L-7.604 Permanent Impairment
R. 69L-7.710 Definitions
R. 69L-7.720 Forms Incorporated by Reference for Medical Billing, Filing and Reporting
R. 69L-7.730 Health Care Provider Medical Billing and Reporting Responsibilities
R. 69L-7.740 Insurer Authorization and Medical Bill Review Responsibilities
R. 69L-7.750 Insurer Electronic Medical Report Filing to the Division

Terms Used In Florida Regulations > Chapter 69L-7

  • Accurately Completed: means the form submitted contains the information necessary to meet the requirements of chapter 440, F. See Florida Regulations 69L-7.710
  • Adjusted: means payment is made with modification to the information provided on the bill. See Florida Regulations 69L-7.710
  • Billing: means the process by which a health care provider submits a medical claim form or medical bill to an insurer, claim administrator or any entity acting on behalf of the insurer, to receive reimbursement for medical services, goods or supplies provided to an injured employee. See Florida Regulations 69L-7.710
  • Catastrophic Event: means the occurrence of an event outside the control of a claim administrator or any entity acting on behalf of the insurer, such as an electronic data transmission failure due to a natural disaster or an act of terrorism (including but not limited to cyber terrorism), in which recovery time will prevent a claim administrator or any entity acting on behalf of the insurer from meeting the filing and reporting requirements of chapter 440, F. See Florida Regulations 69L-7.710
  • Charge Master: means for hospitals a comprehensive listing of all the goods and services for which the facility maintains a separate charge, with the facility's charge for each of the goods and services, regardless of payer type and means; for ASCs a listing of the gross charge for each CPT procedure for which an ASC maintains a separate charge, with the ASC's charge for each CPT procedure, regardless of payer type. See Florida Regulations 69L-7.710
  • Charges: means the dollar amount billed. See Florida Regulations 69L-7.710
  • Claim Administrator: means any insurer, qualified servicing entity, third party administrator, claims-handling entity, self-serviced self-insured employer or fund, guarantee fund, or managing general agent responsible for adjusting workers' compensation claims. See Florida Regulations 69L-7.710
  • Contract: A legal written agreement that becomes binding when signed.
  • Days: means calendar days unless otherwise noted. See Florida Regulations 69L-7.710
  • Denied: means payment is not made because the service rendered is for treatment of a non-compensable injury or illness. See Florida Regulations 69L-7.710
  • Department: means Department of Financial Services (DFS) as defined in subsection 440. See Florida Regulations 69L-7.710
  • Disallowed: means payment for a compensable injury or illness is not made because the service rendered has not been substantiated for reasons of medical necessity, insufficient documentation, lack of authorization or billing error. See Florida Regulations 69L-7.710
  • Division: means the Division of Workers' Compensation (DWC) as defined in subsection 440. See Florida Regulations 69L-7.710
  • Electronic Form Equivalent: means the record, provided in the Florida Medical EDI Implementation Guide MEIG to be used when a sender electronically transmits required data to the Division. See Florida Regulations 69L-7.710
  • Entity: means any party involved in the processing, adjudication or payment of medical bills on behalf of the insurer. See Florida Regulations 69L-7.710
  • Fraud: Intentional deception resulting in injury to another.
  • Implants: means the Surgical Implant(s), the Associated Disposable Instrumentation required for use with the Surgical Implant(s), and shipping and handling, when listed on the implant invoice or certified on the DFS-F5-DWC-90 claim form. See Florida Regulations 69L-7.710
  • Insurer Code Number: means the number the Division assigns to each individual insurer, self-insured employer, self-insured fund, or guaranty fund financially responsible for the claim. See Florida Regulations 69L-7.710
  • Itemized Statement: means a detailed listing of goods, services and supplies provided to an injured employee, including the quantity and charges for each good, service or supply. See Florida Regulations 69L-7.710
  • Medical Bill: means the document or electronic form equivalent submitted by a health care provider to an Insurer, Service Company/Third Party Administrator or any entity acting on behalf of the Insurer for reimbursement for services or supplies (e. See Florida Regulations 69L-7.710
  • NDC Number: means the eleven-digit National Drug Code (NDC) number, assigned under Section 510 of the Federal Food, Drug, and Cosmetic Act, which identifies the drug product labeler/vendor, product, and trade package size. See Florida Regulations 69L-7.710
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Paid: means payment is made applying the applicable reimbursement formula to the medical bill as submitted. See Florida Regulations 69L-7.710
  • Recognized Practitioner: means a non-physician health care provider licensed by the Department of Health who works under the protocol of a physician or who, upon referral from a physician, can render direct billable services that are within the scope of the recognized practitioner's license, independent of the supervision of a Physician. See Florida Regulations 69L-7.710
  • Report: means any form related to medical services rendered, in relation to a workers' compensation injury that is required to be filed with the Division under rule chapter 69L-7, F. See Florida Regulations 69L-7.710
  • Sender: means an Insurer, Service Company/TPA, entity or any other party acting on behalf of an Insurer, Service Company/TPA or any entity to fulfill any Insurer responsibility to electronically transmit required medical data to the Division. See Florida Regulations 69L-7.710