1. A. General: Disputes regarding payment for health or rehabilitation services rendered pursuant to the Workers' Compensation Act may be addressed as set out in this rule. A Form 18 proceeding is an administrative review of disputed medical charges. A Form 19 proceeding may involve judicial resolution of disputed charges for health services. Mediation refers to a voluntary process of resolving disputes with the assistance of a mediator outside of a formal court proceeding.
2. B. Jurisdictional requirement: No Form 18 or Form 19 will be processed by the Workers' Compensation Court unless a Form 2, 3, 3-a or 3-b is filed with the Court; provided, a Form 18 may be processed if the payor's legal representative executes and provides the Court with a submission to limited jurisdiction. The Court has no jurisdiction to hear and resolve disputes where a written contract exists between the employer or insurance carrier and any medical provider, pursuant to 85 O.S., Section 14(E) 14(F).
3. C. Payment of Charges: All charges which comply with the Schedule of Medical and Hospital Fees should be paid by the uninsured or own risk employer or insurance carrier within thirty (30) days of the employer's or carrier's receipt of the bills from the provider. Failure to offer payment of charges within sixty (60) days of receipt of the bills may limit the applicability of the Schedule of Medical and Hospital Fees.

4. D. Form 18 Proceedings:

   1. 1. Disputes arising after a medical charge has been paid, involving conflicting interpretations of the Schedule of Medical and Hospital Fees may be addressed by filing a Form 18, Request for Administrative Review of Medical Charges, as provided in Rule 1 of the Rules of the Administrator of the Workers' Compensation Court.

   2. 2. Either party aggrieved by the Administrator's order directing or denying the payment of medical charges may appeal such order to a judge of the Workers' Compensation Court by filing a Form 19 and a Form 9 within ten (10) days after the Administrator's order is entered. The Form 19 must be appropriately marked to indicate that it is being used to appeal the Administrator's order. The following shall be attached to the Form 9 when filed:

      1. a. A copy of the administrative order appealed from;
      2. b. Copies of all materials submitted to the Administrator in the administrative review proceedings;
      3. c. A statement identifying each portion of the Administrator's order claimed to be in error; and

      4. d. An explanation of how each portion of the Administrator's order urged in error conflicts with the Schedule of Medical and Hospital Fees.

         The appealing party must mail a copy of all materials which are filed in the appeal to each opposing party. No response to the appeal of the Administrator's order is required.

5. E. Form 19 Proceedings:

   1. 1. A rehabilitation provider, case manager or a medical provider may institute proceedings to recover charges rendered for rehabilitation or health services, medicines or supplies which have been provided to a claimant, by the filing of a Form 19, Part I. Request for Payment of Charges for Health or Rehabilitation Services if the provider has not received payment within sixty (60) days from the date the charges were submitted to the uninsured or own risk employer or insurance carrier. A Form 19 may also be filed if the uninsured or own risk employer or insurance carrier has refused liability for the payment of the charges on the following grounds:

      1. a. Length of treatment;
      2. b. Necessity of treatment;
      3. c. Unauthorized physician 85 O.S., Section 14
      4. d. Denial of compensability of the claimant's accidental injury or occupational disease; or
      5. e. Any other objection requiring a judicial determination for resolution.
   2. 2. A provider may request a trial for a determination of the issues raised on the Form 19 by filing a Form 9. The provider shall mail a copy of the Form 9, together with a copy of the Form 19 and itemized bill(s), to the uninsured or own risk employer or insurance carrier in the case. The uninsured or own risk employer or insurance carrier shall file a Form 10M no later than thirty (30) days after the Form 9 is filed.
   3. 3. A medical report signed by a physician shall be offered by both parties in any claim made for the payment or non-payment of medical services when the dispute involves the necessity of the medical services, including claims for treatment rendered in excess of the length of treatment authorized by the Schedule of Medical and Hospital Fees provided for in 85 O.S., Section 14. Medical reports shall be offered by both parties in any claim made for complex treatment rendered beyond the limitation provided in the Schedule of Medical and Hospital Fees.
   4. 4. Audits of medical bills to determine the amount allowable under the appropriate Schedule of Medical and Hospital Fees may be offered by either party. Audits prepared by billing review services, medical bill audit services or in-house auditors may be submitted as evidence reflecting the methodology of the application of the Schedule of Medical and Hospital Fees. The Schedule of Medical and Hospital Fees sets maximum amounts allowable but does not prohibit a party from asserting a lesser amount should be paid.
   5. 5. Form 19 hearings may be scheduled periodically for the Administrator's docket to determine the status of the payment of disputed rehabilitation, case management and medical charges. If the rehabilitation, case management or medical charges are not paid before the hearing or the parties are unable to resolve the dispute at the hearing, the dispute shall be assigned to a judge of the Workers' Compensation Court for hearing on the same date. All parties involved in a Form 19 hearing shall be prepared for trial on such disputed charges.
6. F. Appearances: Providers may appear before the Court in person, by counsel licensed to practice law in the State of Oklahoma or by licensed legal interns. Corporate entities, limited liability companies, insurance companies and own risk employers may appear only by counsel.
7. G. Mediation: Mediation shall be governed by Court Rule 56 and Rule 4 of the Rules of the Administrator of the Workers' Compensation Court.

Adopted by order of the Supreme Court,