47:03:09:01Properly submitted medical bill.

A properly submitted medical bill is a request by a provider for payment of health care services that meets the following requirements: (1) Submitted to the employer according to the applicable reporting and coding standards of the Centers for Medicare and Medicaid Studies, the National Council for Prescription Drug Programs, or the American Dental Association; and (2) Accompanied by sufficient medical records or reports that the employer can determine the reasonableness and necessity of the treatment provided. A submission to a self-insured employer, insurer, medical bill reviewer, medical case management plan, third party administrator, claims adjuster, trustee, guarantor, or other entity having a similar association to the employer is considered submission to all such entities simultaneously. The employer may waive the requirements of this section.

Source: 34 SDR 322, effective June 30, 2008.