4123-6-02.21 Provider access to the HPP - non-certified provider enrollment.

 

 

 

4123-6-02.21               Provider    access      to    the    HPP    -    non-certified                   provider enrollment.

 

 

 

(A)    The bureau may enroll non-certified providers eligible under rule 4123-6-06.2 or 4123-6-10 of the Administrative Code or division (J) (N) of section 4121.44 of the Revised Code to receive reimbursement for goods and services provided to injured workers, and for this purpose may require such non-certified providers to complete and sign an enrollment application and agreement as the bureau deems appropriate, provided such non-certified providers meet the minimum qualifications for their provider category as set forth in paragraph (C) of rule 4123-6-02.2 of the Administrative Code.

 

(B)     Persons or entities who do not fall within the provider categories set forth in paragraph (C) of rule 4123-6-02.2 of the Administrative Code are not eligible for certification as providers. The bureau may enroll such persons or entities to receive reimbursement for goods and services provided to injured workers, and for this purpose may require such persons or entities to complete and sign an enrollment application and agreement as the bureau deems appropriate.

 

(C)  The certification of persons or entities certified as providers prior to the effective date of this rule who do not fall within the provider categories set forth in paragraph (C) of rule 4123-6-02.2 of the Administrative Code shall expire on a schedule determined by the bureau, and such persons or entities shall not be eligible for recertification as providers. The certification of providers who fall within the provider categories set forth in paragraph (C) of rule 4123-6-02.2 of the Administrative Code shall lapse, and the provider shall be enrolled with the bureau only, if the provider has had no billing activity with the bureau for a period of eighteen months or longer while certified. If the provider submits a bill while the provider's certification is lapsed pursuant to this paragraph, the provider may apply for recertification. However, the provider's certification shall remain lapsed until the bureau issues a final order approving or denying the provider's application for recertification.

 

(D)   The enrollment of a non-certified provider, person, or entity pursuant to paragraph paragraphs (A) or, (B), or (C) of this rule shall expire, on a schedule determined by the bureau, if the non-certified provider, person, or entity has had no billing activity with the bureau for a period of two years eighteen months or longer while enrolled as a non-certified provider.

 

(E)   ExpirationLapse of provider certification pursuant to paragraph (C) of this rule and expiration of provider certification or enrollment pursuant to paragraph (C) or (D) of this rule does do not constitute an adjudication order and is are not subject to appeal pursuant to rule 4123-6-17 of the Administrative Code.

 

 

 

 

 

4123-6-02.21                                                                                                                         2

Effective:                                                             11/13/2015

Five Year Review (FYR) Dates:                         08/26/2015 and 08/25/2020

CERTIFIED ELECTRONICALLY

Certification

11/02/2015

Date

Promulgated Under:                           119.03

Statutory Authority:                           4121.12, 4121.121, 4121.30, 4121.31, 4121.44,

4121.441, 4123.05

Rule Amplifies:                                  4121.12, 4121.121, 4121.44, 4121.441

Prior Effective Dates:                         4/1/07, 2/1/10