QME Report Payments - Calendar or Working Days) (California)

[appliedpsych]

My understanding is that LC 4622 now mandates QME payments 60 CALENDER days after receipt by the insurance carrier, including the self-insured organizations.

One Claims Adjustor at a County Government agency is disagreeing and says that it is still 60 WORKING days for governmental organzations.

I know the working days applied in the past, but I thought new changes clarified it to 60 calender days.

The statute at present reads "...within 60 days...".

Any insight for me ? ? ?

[jonbrissman]

The adjuster is apparently confusing the law governing payment for treatment (L.C. Sect. 4603.2) with that applicable to medical-legal charges (Sect. 4622). For treatment charges, governmental entities must pay within 60 working days (it's 45 working days for non-governmental entities). For medical-legal charges, all payers have sixty calendar days. The "working days" concept has never been applicable to medical-legal charges.

JCB

[rider001]

payment for governemtal employee treament correct. not governmental enties.

[jonbrissman]

Rider, I'm not sure what your post means. But L.C. Sect. 4603.2(b)(2) says, in relevant part, " . . .if the employer is a governmental entity, payment for medical treatment provided or authorized by the treating physician selected by the employee or designated by the employer shall be made within 60 working days after receipt of each separate itemization . . . " Governmental entity in this context refers to any employer that is part of state or local government -- CalTrans, CHP, school districts, water districts, SCIF, etc.

JCB

[rider001]

I was seeking clarification for example SCIF is a qasi-governmental entity. In you prior post you state "governmental entities must pay within 60 working days (it's 45 working days for non-governmental entities)" which i dont believe is completly accurate. What was left out of your post was "if the employer is a governmental entity," Otherwise you would be saying all SCIF claims have 60 days to pay when it only applies to those claims for employees who are employed by a branch of the government. I dont mean to split hairs but it is a big difference in the amount of claims that have 60 days to pay and those which are allowed 45. SCIF has problems paying within 6 months to begin with so i guess this is a mute point anyways.

[appliedpsych]

No, I was referring to a self-insured County WC department. They were saying that they get extra time to pay panel QME reports because they are a government agency.

SCIF I have never had any problems with, they usually pay withing 30-45 calender days.