1. (a) The health care provider shall submit all medical bills to the insurance carrier unless the injured employee's employer has indicated a willingness to pay the medical bill(s), and the health care provider elects to bill the employer. If the health care provider bills the employer the health care provider shall submit a copy of the bill to the carrier and shall state the following in bold type: "THIS IS ONLY AN INFORMATION COPY, IT IS NOT A REQUEST FOR PAYMENT."

2. (b) A health care provider who elects to submit medical bills to an employer waives, for the duration of the election period, the rights to:

   1. (1) prompt payment, as provided by §408.027 of the Texas Labor Code;
   2. (2) interest for delayed payment as provided by §413.019 of the Texas Labor Code; and
   3. (3) Commission-provided medical dispute resolution as provided by §413.031 of the Texas Labor Code.
3. (c) A health care provider shall not submit a medical bill later than the first day of the eleventh month after the date the services are provided.
4. (d) If the injured employee, the employee's representative, or the Commission requests an information copy of the medical bill, the health care provider shall send, at no cost, a copy of the medical bill indicating the identical codes and charges from the original medical bill. Information copies shall state the following in bold type: "THIS IS ONLY AN INFORMATION COPY, IT IS NOT A REQUEST FOR PAYMENT."

5. (e) The health care provider that provided the treatment(s) and/or service(s) shall submit its own bill, unless:

   1. (1) the health care provider employs a billing service to perform the solely administrative function of submitting bills for the health care provider,
   2. (2) the health care provider is providing treatment(s) and/or service(s) as part of an interdisciplinary program, in accordance with the Commission fee guidelines in effect for the dates of service,
   3. (3) the health care provider is submitting a bill in accordance with the pathology ground rules of Commission fee guidelines in effect for the dates of service, or
   4. (4) the treatment(s) and/or service(s) was provided by a nonlicensed individual under the direct supervision of a licensed health care provider, in which case the supervising health care provider shall submit the bill.
6. (f) A health care provider or other entity, except as described in subsections (f) and (h) of this section, may not submit a bill for treatment(s) and/or service(s) the health care provider did not provide.

7. (g) Any entity, including a health care provider, that submits a bill for a health care provider shall:

   1. (1) submit the bill for an amount that does not exceed the health care provider's usual and customary charge for the treatment(s) and/or service(s) provided in accordance with §413.011 of the Texas Labor Code,
   2. (2) submit the bill in the name and license number of the licensed health care provider that provided the treatment(s) and/or service(s) or that provided direct supervision of an unlicenced individual that provided the treatment(s) and/or service(s), and
   3. (3) remit to the health care provider that provided the treatment(s) and/or service(s) the full amount that the insurance carrier reimburses for the treatment(s) and/or service(s).

8. (h) A health care provider shall not submit a medical bill to an injured employee for all or part of the charge for any treatment(s) and/or service(s), except as an information copy, or in accordance with §413.042 of the Texas Labor Code. A health care provider shall be deemed to be pursuing a private claim against an injured employee if the health care provider sends a medical bill or account statement to the employee that:

   1. (1) does not clearly state that it is an information copy by including the following in bold type: "THIS IS ONLY AN INFORMATION COPY, IT IS NOT A REQUEST FOR PAYMENT"; and/or
   2. (2) includes a statement that requests payment by asking for remittance of an amount, or that includes something similar to "amount due".
9. (i) An employer, other than a self-insured employer, is not liable for any part of the cost of medical benefits provided to an injured employee, even if a claim is finally adjudicated non-compensable, or the insurance carrier has denied, reduced, or disputed a medical bill. A health care provider shall not submit a medical bill to an employer for charges an insurance carrier has reduced, denied, or disputed.
10. (j) This rule shall apply to all dates of service on or after July 15, 2000.

Source Note:The provisions of this §134.801 adopted to be effective February 20, 1991, 16 TexReg 671; amended to be effective June 1, 1992, 17 TexReg 3250; amended to be effective July 15, 2000, 25 TexReg 2139.