Medical Services Section
Mailing Address: 200 East Gaines Street, Tallahassee, FL 32399-4228
Phone: (850) 413-1613
Fax: (850) 354-5100
- Expert Medical Advisor certification pursuant to Section 440.13(9), Florida Statutes. Expert Medical Advisor database maintenance.
- Reimbursement dispute resolution pursuant to Section 440.13(7), Florida Statutes.
- Investigation and determination of healthcare provider utilization patterns, billing practices or violations of law or rules that may require penalties, pursuant to Section 440.13(8), (11) or (13), Florida Statutes.
- Development of Workers’ Compensation Reimbursement Manuals, in collaboration with the three-member panel, pursuant to Section 440.13(12), Florida Statutes.
- Provision of educational and technical support regarding the aspects of medical services in response to inquiries.
Theresa Pugh, Program Administrator
Expert Medical Advisor (EMA) Certification
HCP Violations/ Reimbursement/ Billing Policy Clarification
Reimbursement Dispute Resolutions
Reimbursement Manual Development Policy/Three Member Panel
Non-Payment Referrals or Inquiries
Florida Statutory References
- Section 440.13(7), Provides regulatory language to resolve reimbursement disputes
- Section 440.13(8), Provides for investigation of health care provider for overutilization and failure to adhere to practice parameters.
- Section 440.13(9), Provides for Expert Medical Advisor certification and delineates
- Section 440.13(11), Provides for investigation of health care providers to determine overutilization, improper billing practices or violations of law or rules and resulting penalties.
- Section 440.13(12), Establishes the three-member panel for development of guides of maximum reimbursement allowances (reimbursement manuals).
- Section 440.13(13), Provides for payment of medical fees to authorized health care providers and establishes a co-payment for employees after reaching maximum medical improvement for the compensable injury.