Cal. Code Regs. tit. 10 § 2592.13
EXPERIENCED MEDICAL BILL REVIEWER DESIGNATION
This Designation is awarded to
______________________________
(Medical Bill Reviewer's Name)
for Experienced Medical Bill Reviewer
as a result of meeting the requirements for workers' compensation medical bill reviewing experience pursuant to California Insurance Code Section 11761 and California Code of Regulations, Title 10, Sections 2592.01 and 2592.05
Total Years of California Experience At Time of Designation: ____________
Designation Given By:
______________________________
(Name of Insurer or Medical Billing Entity)
| ___________________________ | ___________________________ | |
| (Date) | (Signature) |
Name of person awarding designation (print or type):
Title of person awarding designation:
Business address:
Cal. Code Regs. Tit. 10, § 2592.13
Note: Authority cited: Section 11761, Insurance Code. Reference: Section 11761, Insurance Code.