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Utah Administrative Code (Current through November 1, 2019) |
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R590. Insurance, Administration |
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R590-267. Personal Injury Protection Relative Value Study Rule |
| R590-267-1. Authority |
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This rule is promulgated by the insurance commissioner pursuant to Subsections 31A-2-201(3) and 31A-22-307(2). |
| R590-267-2. Purpose |
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(1) The purpose of this rule is to establish a reasonable value of services and accommodations for the diagnosis, care, recovery, or rehabilitation of an injured person under automobile personal injury protection coverage as described in Subsection 31A-22-307(1)(a). (2) As required by Subsection 31A-22-307(2), the reasonable value is based on the 75th percentile of medical, dental, and chiropractic charges, as they presently exist in the most populous county in this State. |
| R590-267-3. Scope |
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This rule applies to services and accommodations provided: (1) under automobile personal injury protection coverage as described in Subsection 31A-22-307(1)(a); and (2) on or after January 1, 2014. |
| R590-267-4. Definitions |
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(1) As used in this rule "Conversion Factor" means a multiplier used to convert the relative value unit or units of a service or a procedure to a reimbursement rate. (2) As used in this rule "RVD 2017" means 2017 Edition of the Relative Values for Dentists published by Optum360, 2525 Lake Park Blvd., Salt Lake City, UT 84120; phone: (800) 464-3649; email: customerassistance@optum.com; website: www.optumcoding.com. (3) As used in this rule "RVD 2015" means 2015 Edition of the Relative Values for Dentists published by Optum360, 2525 Lake Park Blvd., Salt Lake City, UT 84120; phone: (800) 464-3649; email: customerassistance@optum.com; website: www.optumcoding.com. (4) As used in this rule "RVP 2017" means 2017 Edition of the Relative Values for Physicians published by Optum360, 2525 Lake Park Blvd., Salt Lake City, UT 84120; phone: (800) 464-3649; email: customerassistance@optum.com; website: www.optumcoding.com. (5) As used in this rule "RVP 2015" means 2015 Edition of the Relative Values for Physicians published by Optum 360, 2525 Lake Park Blvd., Salt Lake City, UT 84120; phone: (800) 464-3649; email: customerassistance@optum.com; website: www.optumcoding.com. (6) As used in this rule "Relative Value Unit" means a numerical value assigned to a medical or dental procedure as published in RVP and RVD respectively. (7) The publications identified in Subsections R590-267-4(2), (3), (4), and (5) are hereby incorporated by reference within this rule. |
| R590-267-5. Conversion Factors |
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(1)(a) The following conversion factors shall be used with RVP 2017 to determine the reasonable value of medical services or accommodations provided on or after January 1, 2018: (i) anesthesia, 99.27; (ii) surgery, 225.90; (iii) radiology, 37.50; (iv) pathology, 25.00; (v) medicine, 13.00; (vi) evaluation and management, 14.65. (b) The conversion factor used with RVD 2017 to determine the reasonable value of dental services or accommodations provided on or after January 1, 2018 shall be 63.00. (2)(a) The following conversion factors shall be used with RVP 2015 to determine the reasonable value of medical services or accommodations provided from January 1, 2016 through December 31, 2017: (i) anesthesia, 97.13; (ii) surgery, 200.00; (iii) radiology, 35.84; (iv) pathology, 24.29; (v) medicine, 11.67; (vi) evaluation and management, 13.16. (b) The conversion factor used with RVD 2015 to determine the reasonable value of dental services or accommodations provided from January 1, 2016 through December 31, 2017 shall be 60.00. |
| R590-267-6. Fee Schedule |
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The reasonable value of any service or accommodation shall be calculated by multiplying the relative value unit assigned to the service or accommodation by the applicable conversion factor prescribed in R590-267-5. |
| R590-267-7. Penalties |
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A person found to be in violation of this rule shall be subject to penalties as provided under Section 31A-2-308. |
| R590-267-8. Severability |
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If any provision of this rule or its application to any person or situation is held to be invalid, that invalidity shall not affect any other provision or application of this rule which can be given effect without the invalid provision or application, and to this end the provisions of this rule are declared to be severable. |