Provider Bill Review Information
This page provides information about reimbursement of medically necessary expenses under automobile insurance policies in those states where such reimbursement is governed in whole or in part by a state-mandated fee schedule. The following links provide access to applicable statutes, regulations, and administrative rules in automobile fee schedule states. In instances where the fee schedules are not publicly available online, the associated ordering information is listed.
Florida – Florida now reimburses, for the most part, using a percentage of Medicare Part A and Medicare Part B. The statute that sets forth the applicable percentage for the applicable service is found in F.S.A. 627.736(5)(a)(2).
New Jersey – The New Jersey The New Jersey Fee Schedule is listed on the New Jersey Department of Banking and Insurance website. The schedules for the State of New Jersey are provided in seven exhibits:
New York – Learn more about the New York State Insurance Department and its Regulation 68.
Oregon – Oregon reimburses according to workers’ compensation using specific rules.
Pennsylvania – Pennsylvania reimburses at a percentage of Medicare, as detailed in 31 Pa. Code Chapter 69.
Utah – The fee schedule is not a statute or a regulation and is not available online. A copy of the fee schedule can be purchased for $15.00 from:
Jilene Whitby, Information Specialist
Utah Insurance Department
801-538-3803
jwhitby@utah.gov
Vendors
Ingenix – As part of its bill review program, Auto Injury Solutions licenses the Ingenix MDR Medical Methodology from Ingenix, the health care data and technology company headquartered in Minnesota. Auto Injury Solutions uses Ingenix’s Relative Actual Charge Data (“RACD”), sometimes known as usual and customary data, at the percentile level chosen by the respective client. Learn more about Ingenix and the Ingenix MDR Medical Methodology.
Other Companies – Auto Injury Solutions also licenses several other applications from health care data companies:
| Vendor | Product(s) | Description |
| 3M | Core grouping software, Medicare pricer table, New York pricer table | Data are used to properly group, edit, and reimburse inpatient / outpatient claims for FL, HI, NY and PA |
| Thomson MicroMedex | Red book pharmacy | Used to apply average wholesale price (AWP) calculation on pharmacy NDC codes |
| GreatData | Zip code updating | Used to update zip codes |
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