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Workers' Compensation:  Five Steps To Securing Claim Payments

Five steps to successfully secure Workers' Compensation claim payments:

1. Know your state's prior authorization requirements and protections applicable to workers compensation claims.  Most states require treatment plans or other documentation of medical necessity on certain procedures.  Some states penalize carriers that do not provide authorizations in a timely manner when requested. Both Colorado and Florida allow for automatic authorization if an approval or denial is not provided on a timely basis.

2. Verify that claim fields are properly completed and file claims and accompanying reports within your state's applicable Workers Compensation Timely Filing Deadline. Your state's Department of Insurance web site is a good place to look for timely filing requirements.  See http://www.naic.org/state_web_map.htm for your state's link.  Some states, such as Florida, require certain workers compensation claims to be filed within 30 days.

3. Track outstanding days on workers compensation claims and immediately seek penalty payments on late payments if your state sanctions penalty/interest collection by the provider on late payments.  See AppealLettersOnline.com for information regarding letters citing prompt workers compensation payment for each state.

4. Review workers compensation payments for compliance with fee schedule and modifiers usages.  Some states strictly prohibit the downcoding of workers compensation claims and require claims to be resubmitted by the provider with documentation if there is a coding question.

5. Seek dispute resolution, if provided by state mandates, on denied claims to ensure that your claims are given a thorough review.

AppealLettersOnline.com Featured Letters

AppealLettersOnline.com features a topic for workers compensation appeal letters.  This topic will contain letters citing claim processing rules and regulations from each states' workers compensation laws. 

These letters can assist providers with citing state laws in regard to unfairly delayed or reduced medical claims.  Any questions or comments about how to best use these letters can be posted to the AppealLettersOnline.com Users Forum specific to Workers Compensation Claims.

Access the appeal letters at AppealLettersOnline.com

Specialty Highlight:  Chiropractic Visits

Some states, by statute or by regulation, limit the number of chiropractic visits that will be reimbursed under workers' compensation.  At least six states mandate limits on the number of chiropractic visits per case: California (24 visits), Florida (the lesser of 24 visits or 12 weeks of treatment), North Carolina (20 visits), Kansas (21 visits), Hawaii (30 visits over 180 days), and Alaska (46 visits over 1 year).  However, the Alaska, California, Florida and North Carolina regulations permit approval of treatment beyond the standard number of visits if medically justified.  We have state-specific letters for these states citing the applicable mandate and appealing for treatment beyond the state mandated visit limitations based on medical documentation.

Access the appeal letters at AppealLettersOnline.com