| (a) On receipt of medical bills submitted in accordance
with §133.10 of this chapter (relating to Required Billing Forms/Formats),
an insurance carrier must evaluate each medical bill for completeness
as defined in §133.2 of this chapter (relating to Definitions).
(1) Insurance carriers must not return medical bills
that are complete, unless the bill is a duplicate bill.
(2) Within 30 days after the day it receives a medical
bill that is not complete as defined in §133.2 of this chapter,
an insurance carrier must:
(A) complete the bill by adding missing information
already known to the insurance carrier, except for the following:
(i) dates of service;
(ii) procedure or modifier codes;
(iii) number of units; and
(iv) charges; or
(B) return the bill to the sender, in accordance with
subsection (c) of this section.
(3) The insurance carrier may contact the sender to
get the information necessary to make the bill complete, including
the information specified in paragraph (2)(A)(i) - (iv) of this subsection.
If the insurance carrier gets the missing information and completes
the bill, the insurance carrier must document the name and telephone
number of the person who supplied the information.
(b) An insurance carrier must not return a medical
bill except as provided in subsection (a) of this section. When returning
a medical bill, the insurance carrier must include a document identifying
the reasons for returning the bill. The reasons related to the procedure
or modifier codes must identify the reasons by line item.
(c) The proper return of an incomplete medical bill
in accordance with this section fulfills the insurance carrier's obligations
with regard to the incomplete bill.
(d) An insurance carrier must not combine bills submitted
in separate envelopes as a single bill or separate single bills spanning
several pages submitted in a single envelope.
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