287.894. Insurers to report medical claims data to division of workers' compensation, contents--consolidated health plan, duties--purpose--costs--penalty for failure to comply.

MISSOURI STATUTES AND CODES

287.894. Insurers to report medical claims data to division of workers' compensation, contents--consolidated health plan, duties--purpose--costs--penalty for failure to comply.

Insurers to report medical claims data to division of workers'compensation, contents--consolidated health plan,duties--purpose--costs--penalty for failure to comply.

287.894. 1. All commercial insurance carriers licensed to sell workers'compensation insurance in the state shall provide to the Missouri division ofworkers' compensation at least every six months workers' compensation medicalclaims history data as required by the division. Such data shall be onelectronic media and shall include the current procedural and medicalterminology codes relating to the medical treatment, dates of treatment,demographic characteristics of the worker, type of health care providerrendering care, and charges for treatment. The division may require astatistically valid sample of claims. Companies failing to provide suchinformation as required by the division are subject to section 287.740. Thedivision may, for purposes of verification, collect data from health careproviders relating to the treatment of workers' compensation injuries.

2. The Missouri consolidated health care plan as established in section103.005, RSMo, shall, upon request of the division, provide data comparable tothat provided by the insurance carriers as required in subsection 1 of thissection.

3. The data required in subsections 1 and 2 of this section shall beused by the division to determine historical and statistical trends,variations and changes in health care costs associated with workers'compensation patients compared with nonworkers' compensation patients withsimilar injuries and conditions. Such data shall be readily available forreview by users of the workers' compensation system, members of the generalassembly, the Missouri division of workers' compensation and the department ofinsurance, financial institutions and professional registration. Any datareleased by the division shall not identify a patient or health care provider.

4. Any additional personnel or equipment needed by the division to meetthe requirements of this section shall be paid for by the workers'compensation fund.