First in our Series on Workers’ Compensation Rules Update

The North Carolina Industrial Commission (IC) has been busy over the past several months rewriting and readopting ALL of their workers’ compensation rules in accordance with a 2011 General Assembly directive. The North Carolina Medical Society (NCMS) assisted the IC with this work, and was well-positioned to recommend changes that would improve the system for physicians who care for sick and injured workers. We are pleased that the IC followed many of our recommendations.

 To help our members understand the updated rules and how the changes may impact their practices, we’ll be highlighting one new or revised rule each week in the Bulletin. The first rule we’d like to discuss is the new Medical Provider Fee Dispute Resolution Rule.

Physicians and medical practices now have access to a special Fee Dispute Resolution Procedure facilitated by the IC’s Medical Fees Section. Physicians may initiate the process when an employer or carrier refuses to make payments, pays an improper amount, or for any problem related to medical bills and payments. The NCMS has already heard that physicians have been using the new protocol with positive results.

The initial step in the new process is to complete Form 26i  available through either the NCMS website or the Industrial Commission’s Medical Provider website, and send it to the appropriate carrier. This easy, one-page form requests basic information about your practice, the patient, and the carrier. Once received the carrier has 20 days to respond.  Many times, a carrier will make payment after receiving one of these forms.

If the carrier responds to the form that it cannot make payment or resolve the problem, the practice may then notify and involve the IC Medical Fees Section as an informal mediator. The IC will then act as a go-between and attempt to find common ground. If the dispute remains unresolved following this process, the practice has the option of formally intervening as a party in the workers’ comp claim between the employer and employee. The intervention would be for the limited purpose of resolving the fee dispute.

A full description of the procedure is available through a link on the NCMS website or the IC’s homepage. Watch the Bulletin for the next rule in our series on the changing workers’ comp system.  For more information visit the NCMS website’s Workers’ Compensation page.


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