North Dakota Administrative Code

The organization may enter into special agreements for services provided by, or under the direction of, licensed medical service providers authorized to bill the organization. Special agreements may be made for services not covered under the fee schedule and may include multidisc…

1. As soon as reasonably possible after receiving a bill, the organization shall: a. Pay the charge or any portion of the bill that is not denied; b. Deny all or a portion of the bill on the basis that the injury is not compensable, or the service or charge is excessive or not me…

1. A medical service provider shall complete the registration process and corresponding forms identified by the organization to receive payments for services. 2. A medical service provider may not submit a charge for a service which exceeds the amount the medical service provider…

Medical service providers shall submit electronic medical bills and supporting documentation to the organization unless the health care provider is exempt. 1. A medical service provider is exempt from the requirement of electronic submission of medical bills if: a. The provider s…

1. This rule provides the procedures followed for managed care disputes. Retrospective review is the procedure provided for disputing the denial of payment for a medical service charge based on failure to request prior authorization or preservice review. Binding dispute resolutio…

1. Binding dispute resolution must be used for disputing managed care recommendations, including point of sale alterations or denials for pharmacy services. Disputes not arising from managed care must follow the reconsideration and hearing procedures provided by North Dakota Cent…

Repealed effective March 1, 2000. 47

1. For purposes of this section, unless the context otherwise requires: a. "Appropriate record" means a legible medical record or report from a provider, or any other relevant and material information, substantiating the type, nature, extent, and work-relatedness of an injury, wh…

1. Any service performed for another for remuneration under any agreement or contract of hire express or implied is presumed to be employment unless it is shown that the individual performing the service is an independent contractor as determined by the "common law" test. a. An e…

A person may apply to the organization for a determination of whether that person is an employer as that term is defined by North Dakota Century Code title 65. A person claiming not to be an employer under the Workers' Compensation Act has the burden of proving by a preponderance…

1. The organization may reimburse attorney fees and costs under this section regardless of the state in which the injury occurred. 2. The organization retains the ability to select or approve counsel secured by the employer. 3. Employers shall submit attorney billing statements f…

1. The terms used in this section have the same meaning as in North Dakota Century Code title 65 and in North Dakota Administrative Code title 92, except: a. "Covered employment" means hazardous employment principally localized in this state which involves incidental operations i…

Repealed effective July 1, 2006.

Any person, as defined in North Dakota Century Code section 1-01-49, served with a subpoena by the organization which directs the production of copies of documents may charge the organization copying costs. Those persons shall charge, and the organization shall pay, no more than …

As used in subsection 3 of North Dakota Century Code section 65-05-08 and North Dakota Century Code section 65-05-33, "work" means physical or mental effort exerted to do or to make something for any amount of remuneration or physical or mental effort exerted to do or to make som…

Repealed effective May 1, 2002.

Refund. An applicant for a workers' compensation scholarship offered under North Dakota Century Code section 65-05-20.1 must complete the application form required by the organization. The form, at a minimum, must require the applicant provide: 1. Name, address, date of birth, se…

The organization may award grants to entities to promote injured workers' skill upgrading, remedial education, and optimal transition into the labor force. To be eligible, entities must submit proposals that identify a vocational need and explain how the entity intends to meet it…

The organization and an employer may contract for a deductible program. When a deductible program contract is entered, the employer shall reimburse the organization for benefits payable on individual claims up to the agreed deductible amount. The organization shall provide a redu…

The organization may offer dividends to qualifying employers. Eligibility and distribution: 1. Dividends are not guaranteed. 2. If an employer's account has been in effect for less than an entire premium year, any dividend offered shall be prorated by the number of months the emp…

Repealed effective January 1, 2024.

An employer may file an incident report with the organization through the organization's web site. If an incident report is filed with the organization by midnight central time of the next organization business day following the workplace injury or incident and a claim is filed f…

1. Applicants for this premium credit shall complete and submit a complete application provided by the organization. The organization may decline an application for this program. 2. An applicant must be in good standing, as defined in section 92-05-02-01(2), with the organization…

1. History. Legislation enacting the decision review office was passed in 1995 and is codified as North Dakota Century Code section 65-02-27. The legislation took effect on August 1, 1995. 2. Functions. The program has been developed to educate and provide assistance to injured e…

In this chapter: 1. "Act" means the North Dakota Workers Compensation Act. 2. "Attempt to resolve" means a prompt, active, honest, good-faith effort by the claimant to settle disputes with the organization, through the office. 3. "Benefits" means an obligation of the organization…

A claimant shall request assistance with the resolution of a dispute that arises from an order in writing within forty-five days from the date of service of the order. An oral request is sufficient to toll the statutory time limit for requesting rehearing if that request is follo…

1. An injured employee may contact the office for assistance at any time. The injured employee shall contact the office to request assistance with a dispute arising from an order within forty- five days of the date of service of the order. An injured employee shall make an initia…

Repealed effective May 1, 2000. 3

1. "Custody" means incarceration in a facility operated by the department or under contract with the department. 2. "Department" means the department of corrections and rehabilitation. 3. "Inmate" means a person in the custody of the department. 4. "Penitentiary" means the North …

requirements. Unless otherwise provided by statute or rule, if the department has elected to provide modified workers' compensation coverage to inmates working in a prison industries work program, North Dakota Century Code title 65 and North Dakota Administrative Code articles 92…

Inmates working in a prison industries work program are in a single classification under the workforce safety and insurance account for state entities under North Dakota Century Code section 65-04-03.1. The account for this classification will be billed an annual amount equal to …

The department, through the penitentiary, has control over and may direct health care services for an inmate, including the selection of treating and consulting physicians and all other health care provides. The department shall schedule health care services, including medical an…

If the organization and the department determine that an injured inmate is in need of vocational rehabilitation services, the department, through the penitentiary, may provide vocational rehabilitation services to that inmate. Vocational rehabilitation services include penitentia…

If an inmate who has sustained a compensable injury while working in a prison industries work program has been released from custody, the organization shall provide and pay for health care services and procedures for that former inmate according to North Dakota Century Code title…

impairment benefits - Subsequent period of incarceration. Payment of disability benefits, vocational rehabilitation allowance, or permanent partial impairment benefits must be discontinued during any subsequent period of incarceration in any federal, state, regional, or local cor…

Any update, amendment, or revision to title 29 of the Code of Federal Regulations, part 1910, occupational safety and health standards for general industry, and, part 1926, occupational safety and health standards for the construction industry, both promulgated by the occupationa…

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000. 2

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.

Repealed effective June 1, 2000.