La. Admin. Code tit. 40 § I-5341

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

Section I-5341 - Annual Maintenance

A. To ensure that the maximum allowable reimbursement schedule is as fair as possible, the Office of Workers' Compensation will require the carriers/self-insured employers to submit the following information for claims incurred in the preceding period.

1. This information will be reviewed and any changes to the maximum allowable reimbursement rates will be published.

B. Information Required. The information required to review and establish appropriate maximum allowable reimbursement rates will include:

Information		Positions	Type
1	CDT-1 Code	5	Alpha Numeric
2	Provider Name	30	Alpha Numeric
3	Provider Street Address	30	Alpha Numeric
4	Charge Amount per Procedure	10	Numeric
5	Place of Treatment	2	Numeric
6	Date of Injury (yy/mm/dd)	6	Numeric
7	Claimant Name	30	Alpha
8	Claimant Social Security	9	Numeric
9	Employer Name	20	Alpha Numeric
10	Date of Payment of Bill (yy/mm/dd)	6	Numeric

C. Communication Format. The following is the current format, however, the Office of Workers' Compensation will establish the format on an annual basis to facilitate the review:

1. magnetic tape:

a. tape 9-tract, 8.5" to 10.5" reels with silver mylar reflector (standard reels) with write-ring removed;

b. recording density-1600 or 6250 bytes per inch;

c. recording code-extended binary coded decimal interchange code (EBCDIC);

d. header record must identify submitter and position of each field in the record;

e. tape must have a leading tape mark and an end of file mark;

f. the external label must identify the submitter, the date submitted, the tape number with identification of the total number of tapes submitted and the descriptive narrative of the information contained within the records;

2. diskettes:

a. a 5.25 inch diskette (floppy disk) that is IBM PC-DOS compatible with the following attributes:

i. double sided;

ii. double density;

iii. soft sectored;

iv. 9 sectors per track;

v. 40 tracks per diskette;

b. a 3.5 inch, 720K diskette, that is IBM PC-DOS compatible with the following attributes:

i. double sided;

ii. double density;

c. the external label must identify the submitter, the date submitted, the diskette number with identification of the total number of diskettes submitted and the descriptive narrative of the information contained within the records.

D. Maintenance Activities

1. The information submitted will be arrayed in procedure code order.

2. The information for each procedure code will be analyzed to determine the mean value of the charges submitted.

3. This revised information will be published as the update for the maximum allowable reimbursement schedule.

La. Admin. Code tit. 40, § I-5341

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:1169 (September 1993), amended LR 20:1298 (November 1994).

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