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#?
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:
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?:
Name of the worker comp:
What are the other infomration available/provided by rep:
Policy ID:
Payer ID:
Claim Mailing Address:
Additional Comment:
Claim Number:
Call Reference#
Action:
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
You can also check the payer web portal to get WC insurance details if access is available.
ReplyDeleteQuestion can you give the names of portal where from we can check this
The insurance which gives you this denial, you have to check the website of that payer. For accessing you can register on their web portal. Once get the access then you can check the eligibility and get the WC information if available.
DeleteWC insurance - do they have Payer ID, or we need to submit paper claim for them ?
ReplyDeleteYes, they do have. Not all but few WC insurances do have payer ID. For others, you will need to send the paper claim.
DeleteIn some cases patient have a injury and as per insurance policy we cannot submit the patient injury report as per insurance rep said, only patient submit the injury report is it possible patient can submit injury report.
ReplyDeleteWhen there is a work-related injury, the worker needs to report the injury to their WC. If it is not reported and the provider submits the bill to WC then sometimes, it gets denied stating the patient has not reported this injury.
DeleteMaybe you can check if your claim is denied for this reason.
If it is not correct and they still want the patient to submit the bill then you can ask for the reason. Generally, this does not happen.
Where can we check WC eligibility, I asked my supervisor even they do not had the idea. So could you help me with this?
ReplyDeleteFor Auto insurance and WC, it is good to confirm the eligibility on call with an insurance rep.
DeleteThanks
DeleteIf we did some correction on the claim then do we need to submit a CC or fresh claims in scenarios like WC, auto liability and veteran affairs?
ReplyDeleteYes, you can submit the corrected claim. But, sometimes it differs based on insurance. For example, few insurances need a separate form to accept a corrected claim. So, it is good to connect with an insurance rep and confirm the process once that you can follow for all other claims of the same type.
DeleteWhy we can'nt kept comercial insurances primary?
ReplyDeleteSorry why we cann't kept comercial insurances secondary?
ReplyDeleteWC usually settles the claim as primary and there is a very rare chance that commercial insurance will act as a secondary and pay the amount left by WC. But, you can try to bill commercial insurance as secondary for the amount left by WC or if it is not paid by WC. It will at least clarify whether commercial insurance will consider this amount or not.
DeleteThanks for the comment and will make the correction in the above post.