                                 CODE OF VIRGINIA

PROMPT PAYMENT; LIMITATION ON CLAIMS (§ 65.2-605.1)

A. 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.

B. If the itemization or a portion thereof is contested, denied, or considered
incomplete, the employer or the employer&#8217;s workers&#8217; 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. The reasons for contesting or denying the itemization, or the reasons the
   itemization is considered incomplete;

   2. If the itemization is considered incomplete, all additional information
   required to make a decision; and

   3. The remedies available to the health care provider if the health care
   provider disagrees.
   				Payment or denial shall be made within 60 days after receipt from the
   health care provider of the information requested by the employer or
   employer&#8217;s workers&#8217; compensation carrier for an incomplete claim
   under this subsection.

C. 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 &#xA7; 6.2-302 retroactive to the date payment was due
under this section.

D. An employer&#8217;s liability to a health care provider under this section
shall not affect its liability to an employee.

E. No employer or workers&#8217; 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. 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.

G. 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&#8217; Compensation Act, 33 U.S.C. &#xA7; 901 et
seq.

H. The Commission, by January 1, 2016, shall establish a schedule pursuant to
which employers, employers&#8217; workers&#8217; compensation insurance
carriers, and providers of workers&#8217; 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&#8217; compensation medical services
(providers) shall submit their billing, claims, case management, health records,
and all supporting documentation electronically to employers or employers&#8217;
workers&#8217; 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&#8217; 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.

HISTORY: 2014, c. 670; 2015, c. 621; 2016, cc. 279, 290; 2018, c. 261; 2019, c.
760; 2024, c. 177.