Volume 15

15 Fla. L. Weekly Supp. 495a

Insurance — Personal injury protection — Notice of loss — Claim form — License number — Medical provider billing globally for professional and technical component of MRI was required to disclose professional license number of person performing service in box 31 of CMS 1500 form, not merely healthcare facility license number — Summary judgment entered in favor of insurer

15 Fla. L. Weekly Supp. 847a

Insurance — Personal injury protection — Notice of loss — Claim form — License number — Where independent corporate diagnostic testing company that is entitled to submit claim for both professional and technical components of MRI has no professional license and is not required to be professionally licensed, company cannot lawfully comply with statutory provision requiring it to place professional license number on claim form, and form submitted without license number was properly completed — No merit to argument that company should use professional license number of referring physician, interpreting radiologist, or company’s medical director, who did not conduct test — Such use would violate notices on claim form and subject company and physicians to claims of insurance fraud — No merit to argument that failure to place facility license number on claim form precludes notice of loss where explanation of benefits did not address facility license number, and number is not required on form

15 Fla. L. Weekly Supp. 1210a

Insurance — Personal injury protection — Claim form — Professional license number — Where box 31 of CMS-1500 claim form lacks professional license number of medical provider, form does not place insurer on notice of covered loss

15 Fla. L. Weekly Supp. 626aNOT FINAL VERSION OF OPINION
Subsequent Changes at 15 Fla. L. Weekly Supp. 735a

Insurance — Personal injury protection — Notice of loss — Medical bills — Where medical provider’s professional license number was not on medical bills, insurer was not on notice of covered loss — Failure to raise physician license number deficiency prior to litigation did not waive right to assert that charge was in violation of section 627.736(5)(d)

15 Fla. L. Weekly Supp. 374b

Insurance — Personal injury protection — Notice of loss — HCFA claim form — Failure to provide a professional license number in Box 31 of HCFA form does not bar a claim for PIP benefits when provider submitted copies of all professional licenses in its possession along with the bills to the insurer

15 Fla. L. Weekly Supp. 893b

NOT FINAL VERSION OF OPINION
Subsequent Changes at 16 Fla. L. Weekly Supp. 33b

Insurance — Personal injury protection — Notice of loss — Claim form — Professional license number — Error to find that insured substantially complied with notice requirement despite failure to provide doctor’s professional license number on claim form — Waiver — Where, after receiving defective notice, insurer required insured to submit to examination under oath and independent medical examination and failed to alert insured to deficiency, trial court did not err in concluding that insurer waived right to dispute claim based on deficiency

15 Fla. L. Weekly Supp. 726a

Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Authoritative treatises designated by administrative rule prohibit billing range of motion and muscle tests separately from chiropractic manipulation treatment where no coding modifiers are used — No merit to argument that PIP statute allows trial court to consider authoritative treatises designated by rule only if CPT book and items it references are ambiguous — Insurer is not required to pay unbundled charges

15 Fla. L. Weekly Supp. 1114a

Insurance — Personal injury protection — Declaratory judgment — Recoding CPT codes — Where insurer did not make determination that CPT code for unattended electrical stimulation was improperly or incorrectly upcoded or unbundled but, rather, recoded CPT code that Medicare Part B fee schedule does not recognize to synonymous HCPCS system recognized by Medicare Part B fee schedule and explained action in explanation of benefits, insurer was not required to contact medical provider before changing code

15 Fla. L. Weekly Supp. 495b

Insurance — Personal injury protection — Declaratory judgment — Recoding of CPT codes — Where insurer did not make determination that CPT code for unattended electrical stimulation was improperly or incorrectly upcoded or unbundled but, rather, recoded CPT code that Medicare Part B fee schedule does not recognize to synonymous code in HCPCS system recognized by Medicare Part B fee schedule and explained action in explanation of benefits, insurer was not required to contact medical provider before changing code

15 Fla. L. Weekly Supp. 829b

Insurance — Personal injury protection — Recoding CPT codes — No improper recoding occurred where code under which insurer paid bill was synonymous with CPT code referenced in bill for electrical stimulation