Medical Services Section

Mailing Address: 200 East Gaines Street, Tallahassee, FL 32399-4228
Phone: (850) 413-1613
Fax: (850) 354-5100
Email: workers.compmedservice@myfloridacfo.com

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.

Customer Service

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

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.