Ohio Admin. Code 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 (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.
The provider shall notify the bureau within thirty days
of any change in the provider's ownership as reported on the enrollment
application.
(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 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 (A), (B), or (C) of this rule
shall expire if the non-certified provider, person, or entity has had no
billing activity with the bureau for a period of eighteen months or longer
while enrolled as a non-certified provider.
(E) Lapse of provider certification pursuant
to paragraph (C) of this rule and expiration of provider certification or
enrollment pursuant to paragraph (D) of this rule do not constitute an
adjudication order and are not subject to appeal pursuant to rule
4123-6-17
of the Administrative Code.
Notes
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: 04/01/2007, 02/01/2010, 11/13/2015
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(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 (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. The provider shall notify the bureau within thirty days of any change in the provider 's ownership as reported on the enrollment application.
(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 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 (A), (B), or (C) of this rule shall expire if the non-certified provider , person, or entity has had no billing activity with the bureau for a period of eighteen months or longer while enrolled as a non-certified provider .
(E) Lapse of provider certification pursuant to paragraph (C) of this rule and expiration of provider certification or enrollment pursuant to paragraph (D) of this rule do not constitute an adjudication order and are not subject to appeal pursuant to rule 4123-6-17 of the Administrative Code.
Notes
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: 04/01/2007, 02/01/2010, 11/13/2015