Workers’ Compensation in New York is the most complex billing system of the country. NYS WCB imposes rigid reimbursement schedules and constantly evolving regulations. It quickly becomes overwhelming for NY’s busy practices.
Prime Doc Billing streamlines the entire WC billing process to reduce denials and ensure compliance. We manage every claim with our deep expertise so you can focus on patient care, while we secure your payments.
Workers’ Compensation Billing in NY must strictly follow the legal and procedural framework. We stay updated on the rules to avoid penalties for non-compliance and delayed payments.
New York’s WC Billing includes a lot of stakeholders:
Prime Doc Billing ensures communication among all of them by using a centralized billing system.
Our team ensures eligibility by documenting:
We implement strict coverage checks before the services are rendered. This minimizes claim denials or rejections.
New York’s WC billing has a completely different set of forms like C-4 and C-4.2. We ensure all the documentation is submitted electronically by Medical Portal. Our team also conducts compliance checks and internal audits to verify accuracy.
NY payers follow a fixed fee schedule, set by NYS Worker’s Compensation Board. Our medical billing company uses the providers’ billing software to auto-apply current fee schedules. It minimizes underpayments and maximizes your practice’s cash flow.
Any mistake in the above steps can result in delayed payments. Therefore, we submit them correctly the first time to avoid billing errors.
New York’s WC appeal process is often extremely time-consuming. We save time and speed up the process with strategic planning. It includes:
We draft appeal letters accurately and track outcomes through the WCB system to maximize reimbursements.
NYS Workers’ Compensation Billing imposes strict deadlines. We submit the claims within 90 days time frame to get full payment recovery. Our automated workflows help us track every claim from service date till final payment.
NY’s regulations stricty encourages electronic billing submissions via WCB Medical Portal. However, some of the legal cases still require paper submission.
Prime Doc Billing offers a hybrid billing model to submit electronic and paper billing claims as required. We offer service flexibility to ensure compliance and faster reimbursements.
We regularly train our staff with WCB updates to ensure full compliance. Our team also guides providers on the proper use of forms like C-4, C-4.2, and MG-2. This avoids audits, penalties, and claim denials.
Our team monitors NY WCB bulletins to adjust our billing protocols accordingly. We stay ahead of state-specific, timely updates to ensure uninterrupted cash flow.
Prime Doc Billing offers a comprehensive workflow for Workers' Compensation billing. Some of the key steps are given below:
We start by taking patient intake with the following information: Demographics, Employer’s information, Date of injury, Carrier case number. We verify coverage details and claim validity through NYS WCB system. Our team caters to any arising errors to prevent downstream delays.
NY requires pre-authorization for costly treatments and procedures under Medical Treatment Guidelines (MTGs). We monitor authorization status in real-time and follow up aggressively to ensure timely treatments.
We collect, organize and review all the required documents to meet WCB standards. Our team ensures accurate submission to improve the chances of first-pass approval.
Our certified coders specialize in NY WC coding of ICD-10 and CPT. We stay updated with the latest New York-specific policies. Our team also uses billing softwares to automap codes. This ensures accurate charge entry, while decreasing the chances of audits or payment reductions.
Prime Doc Billing handles timely claim submissions through appropriate channels. These channels include the NYS WCB’s XML (Extensible Markup Language) process or secure portals. We also maintain submission records to stay audit-ready at all times.
We maintain each claim’s progress while keeping close communication with carriers. Our team proactively follows up on delays, pending status and missed responses.
At Prime Doc Billing, we specialize in managing denials within New York’s WCB system. Our team investigates and determines the root cause of each denial. This helps us in resubmitting the claims more accurately via WCB-approved XML format.
New York’s WC reimbursements are often approved via Explanation of Benefits (EOBs) or Electronic Remittance Advice (ERAs). Insurance companies then trasnsfer the payments by check or Electronic Funds Transfer (EFT). Our billing team posts payments accurately. We also follow-up on any shortfalls or delayed payments to maintain clear records.
We prepare and submit appeals using NY WCB protocols. Our team supports the appeal with all the necessary documents and medical necessity narratives. Prime Doc Billing has a high success rate in appeal due to timely action and precision.
We provide detailed reporting on NY’s WCB claim status, reimbursement rates and denial trends. This helps us to make informed decision and improve financial outcomes.
Prime Doc Billing provides regular updates directly to providers and other stakeholders. This helps us untangle the complexity of NY WC billing, resulting in minimum delays.
New York’s Workers’ Compensation billing process is quite slow and complex. That is because of the strict billing protocols and extensive documentation requirements by multiple stakeholders. Prime Doc Billing specializes in accelerating reimbursements by:
Using the correct WCB-mandated forms.
Through NYS WCB Medical Portal.
To flag issues before payment delays.
Within WCB timelines.
By staying updated with NYS WC changing regulations.
For NY’s Medical Treatment Guidelines (MTGs).
By combining our deep knowledge of NY Workers’ Compensation laws with specialized billing workflows, we help providers get paid faster.
Get paid faster with Prime Doc Billing’s Workers’ Compensation Billing services. Connect with us now!
Join hundreds of healthcare providers who have transformed their practice with our Workers' Compensation billing services.
(347) 650-2656
(347) 650-2656
info@primedocbilling.com
