{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/65.2-605.1.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/65.2-605.1.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/65.2-605.1.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/65.2-605.1.html"}],"law_id":71627,"edition_id":1,"section_id":71627,"structure_id":14804,"section_number":"65.2-605.1","catch_line":"Prompt payment; limitation on claims","history":"2014, c. 670; 2015, c. 621; 2016, cc. 279, 290; 2018, c. 261; 2019, c. 760; 2024, c. 177.","full_text":"A\n\nPayment for health care services that the employer does not contest, deny, or consider incomplete shall be made to the health care provider within 60 days after receipt of each separate itemization of the health care services provided.B\n\nIf the itemization or a portion thereof is contested, denied, or considered incomplete, the employer or the employer’s workers’ compensation insurance carrier shall notify the health care provider within 45 days after receipt of the itemization that the itemization is contested, denied, or considered incomplete. The notification shall include the following information:1\n\nThe reasons for contesting or denying the itemization, or the reasons the itemization is considered incomplete;2\n\nIf the itemization is considered incomplete, all additional information required to make a decision; and3\n\nThe remedies available to the health care provider if the health care provider disagrees.\n\t\t\t\tPayment or denial shall be made within 60 days after receipt from the health care provider of the information requested by the employer or employer’s workers’ compensation carrier for an incomplete claim under this subsection.C\n\nPayment due for any properly documented health care services that are neither contested within the 45-day period nor paid within the 60-day period, as required by this section, shall be increased by interest at the judgment rate of interest as provided in § 6.2-302 retroactive to the date payment was due under this section.D\n\nAn employer’s liability to a health care provider under this section shall not affect its liability to an employee.E\n\nNo employer or workers’ compensation carrier may seek recovery of a payment made to a health care provider for health care services rendered to a claimant, unless such recovery is sought less than one year from the date payment was made to the health care provider, except in cases of fraud. The Commission shall have jurisdiction over any disputes over recoveries.F\n\nNo health care provider shall submit a claim to the Commission contesting the sufficiency of payment for health care services rendered to a claimant unless (i) such claim is filed within one year of the date the last payment is received by the health care provider pursuant to this section or (ii) if the employer denied or contested payment for any portion of the health care services, then, as to that service or portion thereof, such claim is filed within one year of the date the medical award covering such date of service for a specific item or treatment in question becomes final.G\n\nNo health care provider shall submit, nor shall the Commission adjudicate, any claim to the Commission seeking additional payment for medical services rendered to a claimant before July 1, 2014, if the health care provider has previously accepted payment for the same medical services pursuant to the Longshore and Harbor Workers’ Compensation Act, 33 U.S.C. § 901 et seq.H\n\nThe Commission, by January 1, 2016, shall establish a schedule pursuant to which employers, employers’ workers’ compensation insurance carriers, and providers of workers’ compensation medical services shall be required, by a date determined by the Commission that is no earlier than July 1, 2016, and no later than December 31, 2018, to adopt and implement infrastructure under which (i) providers of workers’ compensation medical services (providers) shall submit their billing, claims, case management, health records, and all supporting documentation electronically to employers or employers’ workers’ compensation insurance carriers, as applicable (payers) and (ii) payers shall return actual payment, claim status, and remittance information electronically to providers that submit their billing and required supporting documentation electronically. The Commission shall establish standards and methods for such electronic submissions and transactions that are consistent with International Association of Industrial Accident Boards and Commission Medical Billing and Payment guidelines. The Commission shall determine the date by which payers and providers shall be required to adopt and implement the infrastructure, which determinations shall be based on the volume and complexity of workers’ compensation cases in which the payer or provider is involved, the resources of the payer or provider, and such other criteria as the Commission determines to be appropriate.","order_by":null,"text":{"0":{"id":258120,"text":"Payment for health care services that the employer does not contest, deny, or consider incomplete shall be made to the health care provider within 60 days after receipt of each separate itemization of the health care services provided.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":258121,"text":"If the itemization or a portion thereof is contested, denied, or considered incomplete, the employer or the employer’s workers’ compensation insurance carrier shall notify the health care provider within 45 days after receipt of the itemization that the itemization is contested, denied, or considered incomplete. The notification shall include the following information:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":258122,"text":"The reasons for contesting or denying the itemization, or the reasons the itemization is considered incomplete;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":258123,"text":"If the itemization is considered incomplete, all additional information required to make a decision; and","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"4":{"id":258124,"text":"The remedies available to the health care provider if the health care provider disagrees.\n\t\t\t\tPayment or denial shall be made within 60 days after receipt from the health care provider of the information requested by the employer or employer’s workers’ compensation carrier for an incomplete claim under this subsection.","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"C"},"5":{"id":258125,"text":"Payment due for any properly documented health care services that are neither contested within the 45-day period nor paid within the 60-day period, as required by this section, shall be increased by interest at the judgment rate of interest as provided in § 6.2-302 retroactive to the date payment was due under this section.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B3","next_prefix":"D"},"6":{"id":258126,"text":"An employer’s liability to a health care provider under this section shall not affect its liability to an employee.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"7":{"id":258127,"text":"No employer or workers’ compensation carrier may seek recovery of a payment made to a health care provider for health care services rendered to a claimant, unless such recovery is sought less than one year from the date payment was made to the health care provider, except in cases of fraud. The Commission shall have jurisdiction over any disputes over recoveries.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"8":{"id":258128,"text":"No health care provider shall submit a claim to the Commission contesting the sufficiency of payment for health care services rendered to a claimant unless (i) such claim is filed within one year of the date the last payment is received by the health care provider pursuant to this section or (ii) if the employer denied or contested payment for any portion of the health care services, then, as to that service or portion thereof, such claim is filed within one year of the date the medical award covering such date of service for a specific item or treatment in question becomes final.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E","next_prefix":"G"},"9":{"id":258129,"text":"No health care provider shall submit, nor shall the Commission adjudicate, any claim to the Commission seeking additional payment for medical services rendered to a claimant before July 1, 2014, if the health care provider has previously accepted payment for the same medical services pursuant to the Longshore and Harbor Workers’ Compensation Act, 33 U.S.C. § 901 et seq.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F","next_prefix":"H"},"10":{"id":258130,"text":"The Commission, by January 1, 2016, shall establish a schedule pursuant to which employers, employers’ workers’ compensation insurance carriers, and providers of workers’ compensation medical services shall be required, by a date determined by the Commission that is no earlier than July 1, 2016, and no later than December 31, 2018, to adopt and implement infrastructure under which (i) providers of workers’ compensation medical services (providers) shall submit their billing, claims, case management, health records, and all supporting documentation electronically to employers or employers’ workers’ compensation insurance carriers, as applicable (payers) and (ii) payers shall return actual payment, claim status, and remittance information electronically to providers that submit their billing and required supporting documentation electronically. The Commission shall establish standards and methods for such electronic submissions and transactions that are consistent with International Association of Industrial Accident Boards and Commission Medical Billing and Payment guidelines. The Commission shall determine the date by which payers and providers shall be required to adopt and implement the infrastructure, which determinations shall be based on the volume and complexity of workers’ compensation cases in which the payer or provider is involved, the resources of the payer or provider, and such other criteria as the Commission determines to be appropriate.","type":"section","prefixes":["H"],"prefix":"H","entire_prefix":"H","prefix_anchor":"H","level":1,"prior_prefix":"G"}},"ancestry":[{"id":14804,"edition_id":1,"name":"Notice of Accident; Filing Claims; Medical Attention and Examination","identifier":"6","label":"chapter","depth":2,"order_by":1,"parent_id":13199,"metadata":{},"date_created":"2026-06-26 03:50:02","date_modified":"2026-06-26 03:50:02","permalink":{"id":276527,"object_type":"structure","relational_id":14804,"identifier":"6","token":"65.2\/6","url":"\/65.2\/6\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13199,"edition_id":1,"name":"Workers' Compensation","identifier":"65.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:44:26","date_modified":"2026-06-26 03:44:26","permalink":{"id":276115,"object_type":"structure","relational_id":13199,"identifier":"65.2","token":"65.2","url":"\/65.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":81142,"structure_id":14804,"section_number":"65.2-600","catch_line":"Notice of accident","url":"\/65.2-600\/","token":"65.2\/6\/65.2-600","metadata":false},{"id":60353,"structure_id":14804,"section_number":"65.2-601","catch_line":"Time for filing claim","url":"\/65.2-601\/","token":"65.2\/6\/65.2-601","metadata":false},{"id":80844,"structure_id":14804,"section_number":"65.2-601.1","catch_line":"Effect of filing claim; stay of debt collection activities by health care providers","url":"\/65.2-601.1\/","token":"65.2\/6\/65.2-601.1","metadata":false},{"id":83079,"structure_id":14804,"section_number":"65.2-601.2","catch_line":"Notice to employee of employer's intent","url":"\/65.2-601.2\/","token":"65.2\/6\/65.2-601.2","metadata":false},{"id":76135,"structure_id":14804,"section_number":"65.2-601.3","catch_line":"Notice of right to dispute claim","url":"\/65.2-601.3\/","token":"65.2\/6\/65.2-601.3","metadata":false},{"id":60208,"structure_id":14804,"section_number":"65.2-602","catch_line":"Tolling of statute of limitations","url":"\/65.2-602\/","token":"65.2\/6\/65.2-602","metadata":false},{"id":82651,"structure_id":14804,"section_number":"65.2-603","catch_line":"Duty to furnish medical attention, etc., and vocational rehabilitation; effect of refusal of employee to accept","url":"\/65.2-603\/","token":"65.2\/6\/65.2-603","metadata":false},{"id":69148,"structure_id":14804,"section_number":"65.2-603.1","catch_line":"Use of therapeutically equivalent drug products required","url":"\/65.2-603.1\/","token":"65.2\/6\/65.2-603.1","metadata":false},{"id":70150,"structure_id":14804,"section_number":"65.2-604","catch_line":"Furnishing copy of medical report","url":"\/65.2-604\/","token":"65.2\/6\/65.2-604","metadata":false},{"id":67541,"structure_id":14804,"section_number":"65.2-605","catch_line":"Liability of employer for medical services ordered by Commission; fee schedules for medical services; malpractice; assistants-at-surgery; coding","url":"\/65.2-605\/","token":"65.2\/6\/65.2-605","metadata":false},{"id":71627,"structure_id":14804,"section_number":"65.2-605.1","catch_line":"Prompt payment; limitation on claims","url":"\/65.2-605.1\/","token":"65.2\/6\/65.2-605.1","metadata":false},{"id":74938,"structure_id":14804,"section_number":"65.2-605.2","catch_line":"Biennial peer-reviewed studies","url":"\/65.2-605.2\/","token":"65.2\/6\/65.2-605.2","metadata":false},{"id":56629,"structure_id":14804,"section_number":"65.2-606","catch_line":"Physicians for medical examination","url":"\/65.2-606\/","token":"65.2\/6\/65.2-606","metadata":false},{"id":71780,"structure_id":14804,"section_number":"65.2-607","catch_line":"Medical examination; physician-patient privilege inapplicable; autopsy","url":"\/65.2-607\/","token":"65.2\/6\/65.2-607","metadata":false}],"previous_section":{"id":67541,"structure_id":14804,"section_number":"65.2-605","catch_line":"Liability of employer for medical services ordered by Commission; fee schedules for medical services; malpractice; assistants-at-surgery; coding","url":"\/65.2-605\/","token":"65.2\/6\/65.2-605","metadata":false},"next_section":{"id":74938,"structure_id":14804,"section_number":"65.2-605.2","catch_line":"Biennial peer-reviewed studies","url":"\/65.2-605.2\/","token":"65.2\/6\/65.2-605.2","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/65.2-605.1\/","history_text":"

This law was first created in 2014. The record of its establishment is cataloged in chapter 670<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 5 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 2015, chapter 621<\/a>; in 2016, chapters 279<\/a> and 290<\/a>; in 2018, chapter 261<\/a>; in 2019, chapter 760<\/a>; in 2024, chapter 177<\/a>.<\/p>","references":[{"id":66371,"section_number":"65.2-714","catch_line":"Fees of attorneys and physicians and hospital charges","order_by":null,"url":"\/65.2-714\/"}],"refers_to":[{"id":70402,"section_number":"6.2-302","catch_line":"Judgment rate of interest","order_by":null,"url":"\/6.2-302\/"}],"permalink":{"id":276569,"object_type":"law","relational_id":71627,"identifier":"65.2-605.1","token":"65.2\/6\/65.2-605.1","url":"\/65.2-605.1\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/65.2-605.1\/","token":"65.2\/6\/65.2-605.1","dublin_core":{"Title":"Prompt payment; limitation on claims","Type":"Text","Format":"text\/html","Identifier":"\u00a7 65.2-605.1","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Payment for health care services that the employer<\/span> does not contest, deny, or consider incomplete shall be made to the health care provider within 60 days after receipt of each separate itemization of the health care services provided. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> If the itemization or a portion thereof is contested, denied, or considered incomplete, the employer<\/span> or the employer<\/span>’s workers’ compensation insurance carrier shall notify the health care provider within 45 days after receipt of the itemization that the itemization is contested, denied, or considered incomplete. The notification shall include the following information: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The reasons for contesting or denying the itemization, or the reasons the itemization is considered incomplete; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> If the itemization is considered incomplete, all additional information required to make a decision; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The remedies available to the health care provider if the health care provider disagrees.\n\t\t\t\tPayment or denial shall be made within 60 days after receipt from the health care provider of the information requested by the employer<\/span> or employer<\/span>’s workers’ compensation carrier for an incomplete claim under this subsection. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Payment due for any properly documented health care services that are neither contested within the 45-day period nor paid within the 60-day period, as required by this section, shall be increased by interest at the judgment<\/span> rate of interest as provided in § 6.2-302<\/a> retroactive to the date payment was due under this section. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> An employer<\/span>’s liability to a health care provider under this section shall not affect its liability to an employee. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> No employer<\/span> or workers’ compensation carrier may seek recovery of a payment made to a health care provider for health care services rendered to a claimant, unless such recovery is sought less than one year from the date payment was made to the health care provider, except in cases of fraud<\/span>. The Commission<\/span> shall have jurisdiction<\/span> over any disputes over recoveries. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> No health care provider shall submit a claim to the Commission<\/span> contesting the sufficiency of payment for health care services rendered to a claimant unless (i) such claim is filed<\/span> within one year of the date the last payment is received by the health care provider pursuant to this section or (ii) if the employer<\/span> denied or contested payment for any portion of the health care services, then, as to that service or portion thereof, such claim is filed<\/span> within one year of the date the medical award<\/span> covering such date of service for a specific item or treatment in question becomes final. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> No health care provider shall submit, nor shall the Commission<\/span> adjudicate<\/span>, any claim to the Commission<\/span> seeking additional payment for medical services rendered to a claimant before July 1, 2014, if the health care provider has previously accepted payment for the same medical services pursuant to the Longshore and Harbor Workers’ Compensation Act, 33 U.S.C. § 901 et seq. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

H.<\/span> The Commission<\/span>, by January 1, 2016, shall establish a schedule pursuant to which employers<\/span>, employers<\/span>’ workers’ compensation insurance carriers, and providers of workers’ compensation medical services shall be required, by a date determined by the Commission<\/span> that is no earlier than July 1, 2016, and no later than December 31, 2018, to adopt and implement infrastructure under which (i) providers of workers’ compensation medical services (providers) shall submit their billing, claims, case management, health records, and all supporting documentation electronically to employers<\/span> or employers<\/span>’ workers’ compensation insurance carriers, as applicable (payers) and (ii) payers shall return actual payment, claim status, and remittance information electronically to providers that submit their billing and required supporting documentation electronically. The Commission<\/span> shall establish standards and methods for such electronic submissions and transactions that are consistent with International Association of Industrial Accident Boards and Commission<\/span> Medical Billing and Payment guidelines. The Commission<\/span> shall determine the date by which payers and providers shall be required to adopt and implement the infrastructure, which determinations shall be based on the volume and complexity of workers’ compensation cases in which the payer or provider is involved, the resources of the payer or provider, and such other criteria as the Commission<\/span> determines to be appropriate. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPROMPT PAYMENT; LIMITATION ON CLAIMS (\u00a7 65.2-605.1)\n\nA. Payment for health care services that the employer does not contest, deny, or\nconsider incomplete shall be made to the health care provider within 60 days\nafter receipt of each separate itemization of the health care services provided.\n\nB. If the itemization or a portion thereof is contested, denied, or considered\nincomplete, the employer or the employer’s workers’ compensation\ninsurance carrier shall notify the health care provider within 45 days after\nreceipt of the itemization that the itemization is contested, denied, or\nconsidered incomplete. The notification shall include the following information:\n\n 1. The reasons for contesting or denying the itemization, or the reasons the\n itemization is considered incomplete;\n\n 2. If the itemization is considered incomplete, all additional information\n required to make a decision; and\n\n 3. The remedies available to the health care provider if the health care\n provider disagrees.\n \t\t\t\tPayment or denial shall be made within 60 days after receipt from the\n health care provider of the information requested by the employer or\n employer’s workers’ compensation carrier for an incomplete claim\n under this subsection.\n\nC. Payment due for any properly documented health care services that are neither\ncontested within the 45-day period nor paid within the 60-day period, as\nrequired by this section, shall be increased by interest at the judgment rate of\ninterest as provided in § 6.2-302 retroactive to the date payment was due\nunder this section.\n\nD. An employer’s liability to a health care provider under this section\nshall not affect its liability to an employee.\n\nE. No employer or workers’ compensation carrier may seek recovery of a\npayment made to a health care provider for health care services rendered to a\nclaimant, unless such recovery is sought less than one year from the date\npayment was made to the health care provider, except in cases of fraud. The\nCommission shall have jurisdiction over any disputes over recoveries.\n\nF. No health care provider shall submit a claim to the Commission contesting the\nsufficiency of payment for health care services rendered to a claimant unless\n(i) such claim is filed within one year of the date the last payment is received\nby the health care provider pursuant to this section or (ii) if the employer\ndenied or contested payment for any portion of the health care services, then,\nas to that service or portion thereof, such claim is filed within one year of\nthe date the medical award covering such date of service for a specific item or\ntreatment in question becomes final.\n\nG. No health care provider shall submit, nor shall the Commission adjudicate,\nany claim to the Commission seeking additional payment for medical services\nrendered to a claimant before July 1, 2014, if the health care provider has\npreviously accepted payment for the same medical services pursuant to the\nLongshore and Harbor Workers’ Compensation Act, 33 U.S.C. § 901 et\nseq.\n\nH. The Commission, by January 1, 2016, shall establish a schedule pursuant to\nwhich employers, employers’ workers’ compensation insurance\ncarriers, and providers of workers’ compensation medical services shall be\nrequired, by a date determined by the Commission that is no earlier than July 1,\n2016, and no later than December 31, 2018, to adopt and implement infrastructure\nunder which (i) providers of workers’ compensation medical services\n(providers) shall submit their billing, claims, case management, health records,\nand all supporting documentation electronically to employers or employers’\nworkers’ compensation insurance carriers, as applicable (payers) and (ii)\npayers shall return actual payment, claim status, and remittance information\nelectronically to providers that submit their billing and required supporting\ndocumentation electronically. The Commission shall establish standards and\nmethods for such electronic submissions and transactions that are consistent\nwith International Association of Industrial Accident Boards and Commission\nMedical Billing and Payment guidelines. The Commission shall determine the date\nby which payers and providers shall be required to adopt and implement the\ninfrastructure, which determinations shall be based on the volume and complexity\nof workers’ compensation cases in which the payer or provider is involved,\nthe resources of the payer or provider, and such other criteria as the\nCommission determines to be appropriate.\n\nHISTORY: 2014, c. 670; 2015, c. 621; 2016, cc. 279, 290; 2018, c. 261; 2019, c.\n760; 2024, c. 177.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}