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Physicians in workers’ compensation cases are defined in Idaho Code as “medical physicians and surgeons, ophthalmologists, otorhinolaryngologists, dentists, osteopaths, osteopathic physicians and surgeons, optometrists, podiatrists, chiropractic physicians, and members of any other healing profession licensed or authorized by the statutes of this state to practice such profession within the scope of their practice as defined by the statutes of this state and as authorized by their licenses.”
This page is designed to provide basic information regarding billing and treatment in workers’ compensation cases. It is by no means exhaustive. Contact the Idaho Industrial Commission for additional information.
Medical Data Reports
2023
- Milliman Report: Idaho Commercial Reimbursement Benchmarking
- NCCI 2023 Medical Data Report for the State of Idaho
2022
- NCCI Medical Data Report for the state of Idaho 2022
- NCCI Medical Data Report for the state of Idaho 2022: Opioid Utilization Supplement
2021
- Milliman Report: Idaho Commercial Reimbursement Benchmarking
- NCCI Medical Data Report for the state of Idaho 2021
- NCCI Medical Data Report for the state of Idaho 2021: Opioid Utilization Supplement
HIPAA
The Industrial Commission has issued a policy statement regarding HIPAA’s application to workers’ compensation and the Idaho Industrial Commission.
Change of Physician
Under the Idaho workers’ compensation system, the employer/surety may assign a medical provider to treat the injured worker. However, the worker may appeal that assignment to the Idaho Industrial Commission.
- Rules for Change of Physician appeals
- Change of Physician, Claimant Request Form
- Change of Physician, Employer/Insurer Response Form
The Commission offers an online coverage verification service. Information regarding the name of the insurer and adjuster covering an employer can be obtained by email.
Idaho is a zero-deductible state for workers’ compensation medical charges. No portion of the unpaid medical bill is to be paid by the injured worker on claims accepted by the surety.
As noted in IDAPA 17.01.01.404, Providers shall submit written medical reports for each medical visit to the Payor. Payers and Providers may contract with one another to identify specific records that will be provided in support of billings. The Provider shall also submit the same written medical reports to the Claimant upon request. These reports shall be submitted within fourteen (14) days following each evaluation, examination and/or treatment. The first copy of any such reports shall be provided to the Payor and the Claimant or Claimant’s Counsel at no charge. If duplicate copies of reports already provided are requested by either the Payor or the Claimant, the Provider may charge the requesting party a reasonable charge to provide the additional reports.
The first copy of any such reports shall be provided to the Payor and the Claimant at no charge. If duplicate copies of reports already provided are requested by either the Payor or the Claimant, the Provider may charge the requesting party a reasonable charge to provide the additional reports.
This means the medical provider must give one free copy to one of each of the following:
- Employer or insurance company
- Claimant (patient) or claimant’s attorney
- The Idaho Industrial Commission