SB 1160 CHANGES TAKING EFFECT January 1, 2018


	BE IN THE KNOW: SB 1160 Effective January 2018

ATHENS eBULLETIN | JANUARY 9, 2018

Athens Managed Care is compliant with these mandates and has incorporated them into our Best Practices for workers’ compensation claims handling.

As a reminder, Senate Bill 1160 was signed into law in 2016 and several provisions of this law became effective on January 1, 2018.

Here is a snapshot of how these changes will impact your workers' compensation program:

1.	Employers must notify employees that they may obtain medical treatment outside workers compensation if their claim is denied.

2.	MPN or predesignated physicians may treat accepted body parts within the first 30 days of the injury without requesting authorization (some exceptions apply).

3.	The provider must submit the required reporting and RFA within five days of the employee’s initial visit.

4.	Providers must submit their bills within 30 days of the date of service.

5.	Adverse determinations from UR are effective for 12 months for requests the same physician or another physician within the same practice group.

6.	UR entities cannot provide financial incentives to physician for specific outcomes.

7.	TPA and Insurers must disclose if there is a financial interest in the UR entity they are referring to.

8.	Timeframes for formulary reviews change to 5 working days for prospective reviews. There is no longer an extension of time if supporting information is needed.

9.	UR will be required to report outcomes to the administrative director.

10.	A request for IMR regarding a formulary dispute must be submitted within 10 days from the date of the UR decision.

11.	IMR must complete the review on formulary disputes within 5 days of receipt of the supporting documentation.

Click here to view additional details on how SB 1160 will impact your California Workers’ Compensation Program.



	Founded in 1976, Athens Administrators delivers superior workers' compensation and liability claims administration services and support with the highest level of personalized attention. We are a full service, customer-centered organization dedicated to creating value and delivering results.		For further information on how we can be your risk management partner, please contact: SOUTHERN CALIFORNIA Michael Landa 949.296.3951 NORTHERN CALIFORNIA Kevin Cichurski 925.826.1103