La. Admin. Code tit. 40 § I-5107

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-5107 - Other Payer Liabilities

A. Whenever a claimant is eligible for Medicare or payment from another third party payer and is also eligible for workers' compensation medical benefits, the carrier/self-insured employer is always the primary payer, the payer of first resort. Services related to compensable conditions should be billed to the carrier/self-insured employer before attempting to collect from the third party payer.

B. If a claimant is receiving treatment for both compensable and noncompensable medical conditions, only those services provided in treatment of compensable conditions should be listed on claims and invoices submitted to the carrier/self-insured employer. In addition, payments from private payers for noncompensable conditions should not be listed on invoices submitted to the carrier/self-insured employer.

C. Charges for noncompensable conditions are collectible by the provider from any other third party payer, subject to the limitations and exclusions contained in the third payer's policy.

La. Admin. Code tit. 40, § I-5107

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.