New Health Care Services Rules from the Workers Compensation Agency

Sep 15, 2018 | General, Workers' Compensation

On March 15th 2018, the new Health Care Services Rules issued by the Workers Compensation Agency (WCA) in relation to how medical providers should go about billing workers compensation, specifically referring to the types of forms that must be used and the timeframe for acceptable payment, went into effect. Medical providers are advised by the WCA to be aware of and familiarize themselves with these new policies to ensure that all medical bills are properly paid.

In accordance with the new Health Care Services Rules, there are three main forms on which charges can be submitted, the CMS 1500 claim form, the UB-04 claim form, and the NCPDP Workers Compensation/Property & Casualty Universal Claim Form. The most common type of form, the CMS 1500, will be acceptable for use by practitioners, hospitals billing for practitioners, hospital-owned occupational clinics, industrial clinics, office practices, and for ancillary service charges such as medical equipment, L-code procedures, hearing services, vision services, ambulance services, and other acceptable medical supplies.

Pharmacies, with the exception of inpatient hospitals, will need to submit charges on NCPDP Workers Compensation/Property & Casualty Universal Claim Forms, or in some cases on normal invoices. UB-04 claim forms, however, will be used exclusively for home health services charges. For doctors of dentistry, charges will need to be submitted on the standard dental claim forms, which are approved by the American Dental Association.    

It is also important to remember that if a provider properly submits a bill to a carrier and does not receive a response within 30 days, another bill must be sent. If the carrier still does not respond to the second submission within an additional 30 days, making for a total of 60 days since the initial bill was sent, the provider will have a right to file an application with the Workers Compensation Agency to request an official hearing or that mediation procedures take place to rectify the situation and ensure that all bills are paid.

Of course, if at any time medical bills are left unpaid and a hearing or mediation process is ineffective in recovering owed compensation, it is advised that you seek professional legal advice and/or representation from qualified workers compensation attorneys, like ours at Atkinson Petruska Kozma Hart & Couture. In most cases, seeking professional legal assistance from workers compensation attorneys will not incur any costs unless payment is recovered. For more information about the new Health Care Services Rules or how to obtain legal representation to help you retrieve any payments you are owed, reach out to one of our workers compensation attorneys at Atkinson Petruska Kozma Hart & Couture, today, by calling us at 1.877.732.2491 or complete our free case review form in the sidebar to receive a prompt response from our one of our knowledgeable staff or attorneys.