claim submission company

Claim Submission

Still Stuck in Paper Claim Submission (Workers' Compensation)

The regulations requiring claims administrators to accept electronic submission of medical bills became effective Oct. 18, 2012. However there is not strict regulation that providers must only submit bills electronically, hence many providers are still using the paper billing option.

Though Electronic claim submission maximizes claims processing efficiency and paper submissions do not. Any claim that can be submitted on paper can be submitted electronically, the information required to file electronic claims is the same as for paper claims but there are major advantages to submitting electronic claims versus paper claims

Advantages of Submitting Claims Electronically:

✔ Insurance companies are obligated to issue payment or Explanation of benefits within 15 days of receipt of properly submitted medical treatment bill.

✔ You have better control and accuracy. Electronic claims are entered in the Insurance Carrier computer system just the way they leave your office. There is no need to worry about a claim being delayed or denied because it is not legible.

✔ You know when your claims are received because your office receives special reports detailing which claims were accepted and if there is a problem you can correct it before the claim is processed.

✔ You are able to reduce your overhead; electronically submitted claims can save hours of clerical time. You do not have to spend time typing, stapling, stamping and mailing.

Disadvantages of Submitting Paper Claims:

✔ The chances that your paper claims will be manually keyed due to form deviation are very high. There is great variety in the UB-92, CMS-1500 (12/90) and CMS-1500 (08/05) forms that insurance has received. When the form that you are using is not up to US Government Printing Office specifications the claim must be manually processed and will be delayed.

✔ Once the claim has to be manually keyed, there is a high rate of error due to undecipherable text.

✔ A duplicate paper claim of an electronic claim will deny and slow down the claim payment process.

Some FAQ's from Department of Workers' Compensation Website:

Q: If the provider or facility chooses to use e-billing, what must the provider or facility do?
Adhere to the specifications in the Medical Billing and Payment Guide and the Companion Guide and the regulations at title 8 California Code of Regulations sections 9792.5.0 – 9792.5.3. A medical provider or facility that chooses to submit bills electronically must also be able to receive an electronic response from the claims administrators. This includes electronic acknowledgements and electronic remittance advice.

Q: When will the provider or facility be paid if the treatment bill is submitted using e-billing?
Uncontested portions of the bill must be paid within 15 working days of receipt of the bill.

Q: When will the provider or facility be paid if the treatment bill is submitted using e-billing?
Uncontested portions of the bill must be paid within 15 working days of receipt of the bill.

Q: How do the electronic billing regulations affect claims administrators?
On and after Oct. 18, 2012, all claims administrators must accept electronic submission of medical treatment bills. The claims administrator may establish its own in-house capacity to handle electronic medical bills or may contract with a vendor to provide electronic bill handling services. The claims administrator must send the provider electronic acknowledgments and remittance advice (explanation of review).

Q: What rules are applicable to electronic billing and bill response?
The electronic billing rules and rules for handling the electronic bills are contained in the following documents:

  • Medical Billing and Payment Guide
  • Electronic Medical Billing and Payment Companion Guide
  • Regulations at title 8 CCR section 9792.5.0 - 9792.5.3
  • Documents incorporated by reference into the guides and rules (for example the ASC X12 Technical Reports Type 3 and the National Council on Prescription Drug Programs Implementation Guides.)

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