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Missouri Workers' Compensation Legal Library

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287.894. Insurers to report medical claims data to division of workers' compensation, contents - consolidated health plan, duties - purpose - costs - penalty for failure to comply. -

1. All commercial insurance carriers licensed to sell workers' compensation insurance in the state shall provide to the Missouri division of workers' compensation at least every six months workers' compensation medical claims history data as required by the division. Such data shall be on electronic media and shall include the current procedural and medical terminology codes relating to the medical treatment, dates of treatment, demographic characteristics of the worker, type of health care provider rendering care, and charges for treatment. The division may require a statistically valid sample of claims. Companies failing to provide such information as required by the division are subject to section 287.740. The division may, for purposes of verification, collect data from health care providers relating to the treatment of workers' compensation injuries.

2. The Missouri consolidated health care plan as established in section 103.005 shall, upon request of the division, provide data comparable to that provided by the insurance carriers as required in subsection 1 of this section.

3. The data required in subsections 1 and 2 of this section shall be used by the division to determine historical and statistical trends, variations and changes in health care costs associated with workers' compensation patients compared with nonworkers' compensation patients with similar injuries and conditions. Such data shall be readily available for review by users of the workers' compensation system, members of the general assembly, the Missouri division of workers' compensation and the department of insurance, financial institutions and professional registration. Any data released by the division shall not identify a patient or health care provider.

4. Any additional personnel or equipment needed by the division to meet the requirements of this section shall be paid for by the workers' compensation fund.

(L. 1993 S.B. 251 § 13, A.L. 2005 S.B. 1 & 130)

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