R 418.101401 Annual medical payment report.

Rule 1401. (1) Payments for medical services received by injured workers shall be reported to the workers' compensation agency on a form prescribed by the agency entitled "Annual Medical Payment Report (WC-406)." The agency shall provide instruction to the carriers and service companies regarding completion of the form. The annual medical payment report shall cover the periods January 1 through December 31 and shall include all of the following information: (a) The total number of medical payments for health care services for medical cases, wage loss cases, and the carrier's total number of worker's compensation cases in each category during the reporting period. (b) Medical only cases, defined as those cases where no indemnity was paid, and the total medical payments made by the carrier for those cases. (c) Wage loss cases, defined as those cases in which wage loss or indemnity was paid, and the total medical payments made by the carrier for those cases. For the purposes of this annual medical payment report, once wage loss benefits are paid, then the case shall always be reported as wage loss. (d) For the purpose of the Annual Medical Payment Report (WC-406), “medical services” is defined as all reasonable medical, surgical, and hospital services and medicines, or other attendance or treatment recognized by the laws in this state as legal, and furnished by licensed practitioners within the scope of their practice. The report shall not include indemnity payments, travel expenses, payments for independent medical examinations, legal expenses, vocational rehabilitation, or on-site or telephonic case management expenses. (2) The annual medical payment report (WC-406) shall be due to the agency by February 28 of each year. Form WC-406 is an online report and must be completed via the Health Care Services Online Program provided on the agency’s website, www.michigan.gov/wca. (3) A carrier, self -insured, or group shall submit required forms either directly or through a third-party vendor, to the agency at such time as the director deems appropriate. The forms required are both of the following: (a) Certification of a carrier's professional health care review program (form WC590). (b) Annual medical report (WC406).