The bill would allow payers to direct prescriptions to pharmacy networks and create limits for physician dispensing and compounds.
The bill would allow payers to direct prescriptions to pharmacy networks and create limits for physician dispensing and compounds.
About 6% of medical bills challenged through the dispute process were initially paid correctly.
Employees could be informed of network pharmacies, while out-of-network pharmacies could be denied reimbursement.
One bill conflicts with existing statutes on the timeline to pay pharmacy bills, while another could be preempted by TRICARE law.
Healthesystems played a significant role in reshaping policy surrounding reimbursement for physician dispensing.
Initiatives for 2026 could affect medical billing, pharmacy programs, treatment guidelines, and administrative processes.
After expanding access to care by allowing these providers to treat injured workers, billing guidelines for these providers are being developed.
The case will examine the Bureau of Workers’ Compensation’s use of RED BOOK for calculating AWP.
Effective January 1st, CARC and RARC codes will be permitted for use in EOBs, leveraging nationally recognized standards.
The bill impacts required medical services, provider choice, preauthorization requests, and more.
The assessment will be based on five key metrics of medical data reported to the DWC from January 1st to June 30th of 2026.
The audits will assess compliance with workers’ comp laws, focusing on timely and accurate payments and proper issuance of medical evaluation notices.
Written comments will be accepted via email until November 10th.
BWC resubmits outpatient medication rules with unchanged compound provisions, sets February 2026 start date, and reopens public comments.
Random audits will review timely and accurate benefit delivery, medical reimbursement, and the reporting of electronic data to the DWC.
