FL DWC To Evaluate EOBR

Tallahassee, FL (CompNewsNetwork) - The Bureau of Monitoring and Audit will add an EOBR review and evaluation component to its claims audits. The EOBR provides the health care provider with the reason(s) for an insurer's reimbursement decisions. Florida EOBR requirements can be found in Rule 69L-7.602(5)(o) and (q), Florida Administrative Code. These requirements have not substantially changed since July 4, 2004.
The required data elements include:
1) Correct use of EOBR codes
2) Correct matching descriptions for EOBR codes
3) Insurer Name
4) Division issued Insurer number
5) Insurer Mailing Address
6) Must specifically state that the EOBR constitutes a “notice of disallowance or adjustment of payment within the meaning of Section 440.13(7), F.S.”
7) Specifically state the name and mailing address of the entity the carrier designates to receive service on behalf of the “carrier and all affected parties” for the purpose of receiving the petitioner's service of a copy of a petition for reimbursement dispute resolution by certified mail, pursuant to Section 440.13(7) F.S.
Each data element listed above will be reviewed on each EOBR for accuracy. For audits conducted between January 1, 2011 and June 30, 2011, the Bureau will begin evaluating the adherence to the EOBR data elements on claims selected for an audit in order to provide feedback to insurers on their EOBR compliance level.
For audits conducted after July 1, 2011, a non-willful pattern and practice violation penalty of $2,500 will be assessed for the EOBR component of the audit if compliance is below 90% for any one EOBR data elements in accordance with Section 440.525(4) F.S., and Rule 69L-24.007 F.A.C..
The Bureau believes that this advance notice will provide insurers with enough time to review, and, if needed, update their EOBR process in order to comply with Rule 69L-7.602(5)(o) and (q), F.A.C.

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