Orthopedia Associates of Hawaii12/7/2005
FOR PUBLICATION
MOON, C.J., LEVINSON, JJ.; CIRCUIT JUDGE WALDORF, IN PLACE OF NAKAYAMA, J., RECUSED; INTERMEDIATE COURT OF APPEALS ASSOCIATE JUDGE LIM, IN PLACE OF ACOBA, J., RECUSED; AND CIRCUIT JUDGE HIRAI, IN PLACE OF DUFFY, J., RECUSED
Plaintiffs-appellants, approximately 322 unaffiliated Hawaii health care providers [hereinafter, collectively, the providers], bring this interlocutory appeal pursuant to Hawaii Revised Statutes (HRS) § 641-1(b) (1993), challenging the August 30, 2001 non-final appealable ruling of the Circuit Court of the First Circuit, the Honorable Virginia L. Crandall presiding, denying their motion for partial summary judgment and granting partial summary judgment in favor of defendants-appellees automobile insurers and adjusters [hereinafter, collectively, the insurers].
On appeal, the providers argue that the circuit court erred in: (1) finding that the written notice of denial of benefits mandated by HRS § 431:10C-304(3)(B) (1993), quoted infra, [hereinafter, HRS § 431:10C-304(3)(B), Section (3)(B), or the subject statute] is inapplicable to the subject billing disputes; (2) concluding that Hawaii Administrative Rules (HAR) § 16-23-120 (1993), quoted infra, applies; and (3) retroactively applying the May 30, 2000 legislative amendments to the subject statute and the September 18, 2000 Insurance Commissioner's Order in GEICO v. Dep't of Commerce & Consumer Affairs (DCCA), INS-DR-2001-1.
For the reasons discussed herein, we vacate the circuit court's August 30, 2001 order denying the providers' motion for partial summary judgment and granting partial summary judgment in favor of the insurers and remand this case for further proceedings consistent with this opinion.
I. BACKGROUND
A. Factual Background
The facts of this case are uncontested. Between January 1, 1993 and December 31, 1999, each of the providers submitted bills to one or more of the insurers for non-emergency treatments rendered to thousands of personal injury protection (PIP) insureds allegedly injured in motor vehicle accidents. The insurers were obligated to pay appropriate PIP benefits under HRS chapter 431:10C on behalf of their insureds. For purposes of billing, the existing workers' compensation fee schedule was adopted as the payment fee schedule applicable to medical and rehabilitative services provided as no-fault benefits for persons injured in automobile accidents. HRS §§ 431:10C-308.5(a) and (b) (1993). Under section 431:10C-308.5(a), "the term 'workers' compensation schedules' means the schedules adopted and . . . establishing fees and frequency of treatment guidelines." The workers' compensation schedule assigns a medical procedure code and a fee to each item of service rendered by health care providers. The providers, in preparing their bills for submission to the insurers, are required to follow the "fees and frequency of treatment guidelines" contained in the workers' compensation schedules. HRS § 431:10C-308.5(b). The insurers, however, rather than pay the bills as submitted, or deny the claim (in whole or in part), altered the treatment code because they believed that, " ased on the available information, the services rendered appear to be best described by [a different medical treatment] code." The resulting effect of changing the treatment codes was a reduction in the payment for the service rendered, which the parties generally refer to as "down-coding." The insurers, thus, (1) paid the bills pursuant to the adjusted treatment codes and (2) offered to negotiate with the providers as to the unpaid portions.
B. Procedural Background
On April 15, 1998, the providers filed a complain
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