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Advisory 96-04

ELECTRONIC SUBMISSION OF MEDICAL BILLS FROM PROVIDERS TO INSURANCE CARRIERS

The following information is provided by the Commission to health care providers and insurance carriers submitting or receiving workers' compensation medical bills.

Many health care providers have expressed an interest in submitting medical bills electronically to insurance carriers for reimbursement. According to insurance carriers and health care providers, the transition from paper copy to electronic transmission of medical bills will prove to be cost-effective and may increase the accuracy of data for all parties involved. Providers may experience more expedient reimbursement from the carriers. Coordination must occur between the parties involved in the electronic transmission of medical bills to ensure capability to transmit/accept the required data.

Health care providers submitting bills electronically must continue to comply with current Commission-prescribed instructions and applicable rules in completing the medical bills. The carrier will reject, with notification to the provider, any improperly transmitted bill within seven (7) days of receipt. For documentation of procedures (DOP), carriers must be able to accept and match medical records to corresponding electronic medical bills since DOPs may be sent separately from the bill. Providers must also be able to generate a paper copy of the electronically submitted bill at the Commission's or carrier's request.

Insurance carriers must continue to process and annotate bills in accordance with the Commission rules and procedures to include but not limited to MBIN, date received, date paid, exception codes, amount paid for each service, and total amount paid. Upon approval by the Commission, the carrier's annotated transmission of required information to the provider may serve as an Alternate TWCC-62. The carrier must be able to generate a paper copy of the bill as submitted from the provider with required annotated information upon request. The Commission will also continue to require a paper copy of the bill when disputed issues occur.

All medical bill data will be maintained by insurance carriers for twenty-four (24) months after the bills are accepted electronically by the Commission; hard copy medical bills in hard copy files; and electronically transmitted bills in electronic files.

Advisory 96-04 is not a requirement that providers submit medical bills electronically to the carriers. Rather, it is to allow the option to reduce paper and to increase cost savings and efficiency where insurance carriers are equipped to receive electronic transmission of medical billing data.

Signed April 1, 1996

Todd K. Brown, Executive Director



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