19: This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier

On Call Scenario:

                                                 Claim denied as This is a work-related
                                                  injury/illness and thus the liability of 
                                                   the Worker's Compensation Carrier
                                                                             ↓
                                                           May I get the denial date?
                                                                             ↓
                                                        Could you please provide the 
                                                        worker compensation details?
                                                                            ↓
                                                          Does rep have the details?
                                                        ↙                                          ↘
                                                   Yes                                              No
                                                ↙                                                         ↘
              What is the name, policy id, payer id &                      May I have the  
                 mailing address of worker comp?                         claim# & call ref#?

                                           ↓

                   May I have the claim# & call ref#?

Important Note:

• If the rep does not have worker compensation carrier details then check in the system if there is any WC insurance available or patient payment history has any WC insurance as primary, if yes then check eligibility for that insurance and resubmit the claim to that payer or else release the claim to the patient if WC insurance information is not available.
• You can also check the payer web portal to get WC insurance details if access is available.
• When the rep provides all the details of the worker comp then you can update that insurance as primary and resubmit the claim to primary insurance. Do not keep commercial payer as secondary insurance.
• Medicare can be kept as secondary insurance and when the worker comp leaves the balance as patient responsibility then bill to medicare after updating the MSP code.

Prepare Notes:

Source of Status:

* Call Website EOB System

Clearing House Comment (Please make the changes if required):

Insurance Name:

*

Clearing House Name:

Insurance Phone#:

*

Rep Name:

*

Website Name:

*

Denial Date:

*

Did rep have the worker comp information?/Is worker comp information available?:

* Yes No

Name of the worker comp:

*

What are the other infomration available/provided by rep:

* Policy ID Policy ID and Payer ID Policy ID and Mailing Address Payer ID and Mailing Address Policy ID, Payer ID and Mailing Address None

Policy ID:

*

Payer ID:

*

Claim Mailing Address:

*

Additional Comment:

Claim Number:

*

Call Reference#

*

Action:

* Claim released to patient Updated the worker comp as primary and resubmitted the claim Need client assistance Need to allow more time



In the below box, final notes will be displayed once you click on Submit button and this box is editable, so you can make the changes as per the requirement

Note: We are not saving any of your inputs or notes in the backend