§ 122.620. Role of the CCO in billing.
(a) A CCO, to ensure reimbursement of its participating coordinated care providers in accordance with the reimbursement arrangements it may negotiate with an employer or workers’ compensation insurer, may do the following:
(1) Require the bills of participating coordinated care providers for treatment of injured workers selecting the CCO to be sent to the CCO for repricing in accordance with its contract with the employer or workers’ compensation insurer.
(2) Forward repriced, accurate bills to the self-insured employer or the employer’s workers’ compensation insurer for direct payment to the participating coordinated care provider.
(b) The CCO may propose for Department review other methods to ensure that participating coordinated care provider bills are accurately and promptly identified as CCO related bills subject to the negotiated fee established between the CCO and the self-insured employer or workers’ compensation insurer.
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