Author Topic: Work Comp and Major Med  (Read 293 times)

Chiro Billing Collect

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Work Comp and Major Med
« on: January 25, 2018, 10:41:30 AM »

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

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Re: Work Comp and Major Med
« Reply #1 on: January 25, 2018, 07:29:11 PM »
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. 
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PMRNC

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Re: Work Comp and Major Med
« Reply #2 on: January 27, 2018, 03:11:03 AM »
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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