The type of insurance plan that covers treatment related to workplace injuries and ailments, known as workers’ compensation, provides financial assistance to employers who purchase it. The requirements and documentation for this are unique, necessitating medical billing professionals who are billing claims associated with these plans. They must be aware of the limitations of the plans.
Unique Features of the Workers’ Comp Plans
Workers’ comp claims, unlike other common health insurance plans, are manually processed. Industry standard related to most third-party payers being automatic processing of medical claims via electronic data interchange, workers’ comp medical claims are processed manually. It is necessary to ensure that injury-specific and work-related conditions are being treated under these plans.
The Process of Workers’ Comp
Upon being injured or having contracted a work-related medical condition, the employee will file a claim with the insurance carrier of the employer. A claim number will be assigned; it acts like an insurance ID number for claiming reimbursement. An adjuster will be assigned for the employee too, who authorizes the medical services provided to the employee.
With the relevant information about the employee, the provider’s office takes care of services. The employee’s personal insurance plans will not be involved for the services related to the injury. Nonetheless, non-related services will be billed to the personal insurance of the patient.
Workers’ comp claims may be submitted in the CMS-1500 claim form, similar to other health insurance claims. The adjuster has to review the charges and the supporting documentation for ensuring that medical services are for work-related medical conditions only. Confirming that the charges are appropriate, the adjuster reprises them in line with the carrier’s fee schedule.
Medical billing and coding solutions offered by Numinatrans enables business organizations and agencies to comply with regulatory requirements, while achieving submission of accurate and timely claims.
If you are looking for reliable and effective medical billing solutions, you are welcome to approach us. Log on to http://www.numinatrans.com/services/medical-billing/ for more details.