Our process starts from taking up the case, reviewing the same, collect all required data relevant to the case, raise pre-authorization to ensure approvals of claims faster, create medical coding accurately, and submit the billing forms to WCB, review and follow up on payments, denial management, second bill review and collection of payments.
Taking Up the Case- Intake of the case is very critical and crucial in the entire process. The insurance carrier must verify the entire employment and injury details of the worker and ensure that it is a valid case in Workers’ Compensation Appeals Board (WCAB).
Collection of Data & Review & Verification of the Case – When the case has been approved and treatment is undertaken, other data pertaining to the case and processing of payment are collected and they should be thoroughly verified. The insurance details must also be verified to understand any adjusters etc.
Raise Pre-authorization Request – Raise pre-authorization request for approved case. This is a mandate process. This is to substantiate required treatment for the patient. Also, it will help in faster clearance of bills and collections.
Accurate Medical Coding – Once the authorization is received and medical treatment is complete, the necessary medical reports are obtained. Basis the reports, coding is done for medical billing. The created codes are checked thoroughly to ensure that medical coding is as per the current and revised standards.
Creation and Submission of Forms – Basis the medical reports and coding, the bills are created and submitted to the carrier for payments. Timely submission of bills is very important for the timely clearance and collection of the payments.
Denial Management and Review – There may be times, when the bills are rejected due to various reasons. Also, at times, the payer does not pay the entire amount eligible. These bills are scrutinized for reviewed further. Second bill is submitted with the required explanation within the stipulated period of time.
Collection of Payments – Once the bill is through without any errors, timely and constant follow up is done with the insurance payers to collect the payments in least time possible.
We at BIS will help you make more money in workers compensation billing collections. Outsource workers’ compensation billing and collections to us and stay at ease! We manage the end-end workers’ compensation billing and collections process and help enhance your revenue.