Billing > Billing

Work Comp and Major Med

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Chiro Billing Collect:

What is the policy on billing a patient's major med carrier if WC claims are denied, specifically in New York? For example, patient is denied authorization for WC or treatment is outside the guidelines and claims are denied. Should we wait for the WCB hearing before we bill major med? Or can we not bill major med at all?

Thank you!

Michele:
If it is outside the guidelines, and there was no exacerbation to warrant additional treatment then you can bill the major medical with the denial from the WC carrier.  Without an exacerbation additional visits will not be granted. 

PMRNC:
We always get an LOP from the attorney..and if we get denial from WC we attach it to the Major medical plan claim..sometimes we are told the claim has to go through review policy. If this happens we end up waiting but we have the LOP from the attorney so that we have a guarantee of payment.

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