Author Topic: Work Comp and Major Med  (Read 890 times)

Chiro Billing Collect

  • Newbie
  • *
  • Posts: 33
Work Comp and Major Med
« on: January 25, 2018, 01:41:30 PM »

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!


  • Global Moderator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Work Comp and Major Med
« Reply #1 on: January 25, 2018, 10:29:11 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. 
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF


  • Hero Member
  • *****
  • Posts: 4562
    • One Stop Resources & Networking for Medical Billers
Re: Work Comp and Major Med
« Reply #2 on: January 27, 2018, 06:11:03 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.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers

Medical Billing Forum

Re: Work Comp and Major Med
« Reply #2 on: January 27, 2018, 06:11:03 AM »