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Physicians in workers' compensation cases are defined in Idaho Code as
"medical physicians and surgeons, ophthalmologists, otorhinolaryngologists,
dentists, osteopaths, osteopathic physicians and surgeons, optometrists,
podiatrists, chiropractic physicians, and members of any other healing
profession licensed or authorized by the statutes of this state to practice
such profession within the scope of their practice as defined by the
statutes of this state and as authorized by their licenses."
This page is designed to provide basic information regarding billing and
treatment in workers' compensation cases. It is by no means exhaustive.
Contact the Idaho Industrial Commission for additional information.
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Coverage Information |
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The Commission offers an online coverage verification service.
Click here to access it.
Information regarding the name of the insurer and adjuster covering an
employer can be obtained by email. Send your information request to
SuretyRequest@iic.idaho.gov .
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Medical Records |
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According to Administrative Rule 17.02.04.322:
Providers shall submit written medical reports for each medical
visit to the Payor. Payers and Providers may contract with one another
to identify specific records that will be provided in support of
billings. The Provider shall also submit the same written medical
reports to the Claimant upon request. These reports shall be submitted
within fourteen (14) days following each evaluation, examination
and/or treatment. The first copy of any such reports shall be provided
to the Payor and the Claimant or Claimant's Counsel at no charge. If duplicate copies of
reports already provided are requested by either the Payor or the
Claimant, the Provider may charge the requesting party a reasonable
charge to provide the additional reports.
The first copy of any such reports shall be provided to
the Payor and the Claimant at no charge. If duplicate copies of reports
already provided are requested by either the Payor or the Claimant, the
Provider may charge the requesting party a reasonable charge to provide
the additional reports.
This means the medical provider must give one free
copy to one of each of the following:
- Employer or insurance company
- Claimant (patient) or claimant’s attorney
- The Idaho Industrial Commission
A letter of clarification from
the Commission is available on-line.
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HIPAA and Workers' Compensation |
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The Industrial Commission has issued a policy
statement regarding HIPAA's application to workers' compensation and the
Idaho Industrial Commission.
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Change
of Physician |
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Under the Idaho workers' compensation system, the employer/surety may
assign a medical provider to treat the injured worker. However, the worker
may appeal that assignment to the Idaho Industrial Commission.
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