Licensing fee schedules is based on the number of users in your organization. A User is an individual who uses information from the ground rules and/or rate tables to make decisions about, to charge or to pay for services related to claims for injured workers.
Examples:
- A physician practice using the fee schedule to bill for services provided to a patient who was injured at work
- Anyone adjudicating a bill whereby the fee schedule is used to price services
- A business analyst interpreting rules and regulations for automation into a software program for bill adjudication, analysis, reporting or other needs
- A claims processor at an insurer/TPA/bill review agency or employer who is reviewing a workers’ compensation bill to evaluate appropriate review or payment for medical services
- Reviewing a bill for the purposes of adjusting or completing a potential re-evaluation due to errors, a state or hearing directive or a provider dispute
- Reviewing the fee schedule information for purposes of preparing litigation, attending a hearing or arbitration
The following example would NOT be considered Users of the fee schedule:
- IT staff who load the fee schedule to a company’s computer system or software program for use by claims processors or bill reviewers, running reports or other IT functions
If you have any questions about user definitions, please contact FAIR Health client services.
855-301-3247
service@fairhealth.org
