Efficient and Compliant Workers' Compensation Billing Services Across the USA

End-to-End Billing Solutions

From patient intake to filing for an appeal, we handle end-to-end workers’ compensation billing. We manage each billing cycle with extreme precision to avoid any errors. Our focus is to get maximum reimbursement for workers’ compensation from the company’s insurance.

Fast and Transparent Reimbursements

With our advanced billing systems, we help you get faster reimbursements with complete transparency. We tailor our services specifically for workers’ compensation to maintain smooth operations.

State-Compliant Claim Submission

Prime Doc Billing’s claim submission processes are designed as per the state’s regulations. Our team applies correct rules and codes for each jurisdiction to avoid claim denials.

First Report of Injury

We assist in gathering all the important information regarding the first report of injury. Our team ensures necessary timelines and starts the claim submission process without any delay.

WC Claim Forms

We prepare and submit forms required by the state and insurance providers, ensuring complete documentation accuracy. Workers’ compensation billing requires CMS-1500, UB-04 (for hospitals), and state-specific forms for claim submission.

Patient Intake

We collect and organize patients’ demographics, employment details, and treatment plans to submit claims to their insurance carriers.

Insurance Eligibility and Verification

Our team verifies insurance eligibility from the employer and payer to confirm claim verification. We do so before the services are rendered, so it does not get in the way of patients’ treatment.

Utilization Review

Utilization review is typically necessary in workers’ compensation billing. It includes preauthorization and verifying if the treatment recommended is medically necessary for the patient.

Prime Doc Billing conducts utilization review and coordinates with the payers and employers. We ensure that the treatment protocols meet state guidelines. We also provide clinical paperwork to verify that the treatment plan is medically accurate for the patients’ condition.

Billing and Coding

We apply state-specific billing codes like ICD, CPT, and NCCI. Our team provides accurate coding and documentation in the first attempt to avoid claim denials.

Claim Submission

Claims are either submitted electronically or via other channels as per the jurisdictions’ requirements. We gather all the documentation accurately and send it for claim submission.

Claim Tracking

We stay up-to-date with claim tracking through every stage. We identify the problems early and take proactive actions to resolve issues quickly.

Appeal

If the insurance companies deny or underpay the claim, we file for an appeal. The patients have the right to ask for IMR (Independent Medical Review). A certified neutral doctor conducts IMR to resolve the payer’s dispute.

Prime Doc Billing files for an IMR within 30 days of the denial. We take care of the necessary paperwork and submit it accurately.

Customized Reporting

We provide customized reports to all the parties and analyze performance metrics so the providers can have full visibility into their revenue cycle.

State-Specific Compliance

We ensure compliance in every claim according to the state’s laws. Our team handles the information with utmost care so that none of the parties gets any harm in the process.

Pain Management Clinics

Usually, the construction workers who suffer from back, hand, or leg pain are referred to pain management clinics. We verify the claim with the employer’s insurance first. After that, we obtain prior authorization for any pain meds or injections prescribed by the doctor.

We accurately code procedures using Workers’ Compensation-specific requirements. Our team timely bills the claim and maintains compliance to ensure timely reimbursements.

Orthopedic and Chiropractic Practices

If an employee happens to fall and fracture their bones while working, they are referred to orthopedic and chiropractic practices. We ask for prior authorization first if there are procedures like an MRI or a CT scan.

Our team handles extensive paperwork required for surgeries, imaging, and follow-up visits. If the claim is denied, we file for an appeal to continue patients’ treatment without any delay.

Physical Therapists

Workers recovering from surgeries or pain are recommended to see physical therapists. Our team authorizes the limit of sessions and treatment before starting the therapy. We submit the billing claims for each session separately and track progress to make necessary adjustments.

Urgent Care Centers

We ensure accurate documentation for urgent care centers as well. Our experts have in-depth knowledge of every field and its requirements, according to the state.

Reduced Claim Denials and Delays

There are two main reasons for claim denials and delays:

• Incorrect documentation
• Coding error

Our team ensures both documentation and coding are accurate and up-to-date. We submit it correctly the first time to reduce the chances of claim denials in the process.

Improved Reimbursement Cycles

Our experts focus on reducing the time between claim submission and reimbursement. We streamline the entire billing process, ensuring faster cash flow for the providers.

The providers trust Prime Doc Billing for improved reimbursement cycles, as we have always delivered maximum results in revenue flow.

Compliance with State and Federal WC Laws

Our experts remain up-to-date with the current policies of state and federal WC laws. That makes it easier for us to stay compliant and keep the workers’ information completely confidential.