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Property and Casualty (workers' compensation and auto injury) Toolkit

Workers' Compensation State-Specific Resources
Use the interactive map to learn how to submit a Workers' Compensation bill in each state.

Opportunity for revenue enhancement: How to automate your property and casualty claims submission and attachment processes
Physicians and practice staff who bill services for property and casualty deal with a process which can often be confusing and time consuming.  Did you know that there are already hundreds of such payers who accept electronic billing for services? In some states (jurisdictions), it is mandatory to submit electronic health care transactions for workers' compensation via Electronic Data Interchange (EDI) methods.

The AMA advocates for one workflow for all lines of business.  This toolkit helps you incorporate property and casualty (workers' compensation and auto injury) billing into your existing commercial claim processing workflow.

Electronic billing (eBilling) for property and casualty bills can dramatically cut your practice's billing and payment cycles, while improving your interaction with payers by:

  • replacing paper bills and attachments with electronic health care transactions that, in many cases, can be sent through their existing practice management system, billing service and/or clearinghouse vendors
  • minimizing bill rejections by electronically submitting claims and attachments in one electronic submission
  • increasing cash flows by eliminating multiple submissions via mail, and freeing up time for revenue-enhancing functions, such as ensuring accurate payment
  • reducing your bill (claim) submission costs by over 55%
    • cost to submit manual bills (claims): $6.63 x 6,200 = $41,106
    • cost to submit electronic bills (claims): $2.90 x 6,200 = $17,980
    • annual savings per physician from automating bill (claims) submission: $23,126*

*Based on an annual average of 6,200 claims submitted for a single physician.  Source: Milliman, Inc., "Electronic Transaction Savings Opportunities for Physician Practices." Technology and Operations Solutions.  Revised: Jan. 2006.

 

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Workers' compensation eBilling webinar

"How to automate your Workers' Compensation claims"
Watch an archived webinar presented by Don St. Jacques, Jopari, Inc., to learn how to automate your workers’ compensation claims process.  View this webinar to learn five easy steps to get started using workers’ compensation eBilling today.

Property and casualty (workers' compensation and auto injury) toolkit

Easily print all of the property and casualty (workers' compensation and auto injury) toolkit resources together that are listed below.

How do you process a workers' compensation bill on a commercial claim form?

Before submitting paper or electronic bills, make sure you understand the specific state billing formats and data requirements.  This information can be obtained by contacting each State Division of Workers' Compensation or accessing their website.  You can access the AMA's interactive state-specific resource map, to learn how to submit a workers' compensation bill in each state.

Property and casualty (workers' compensation and auto injury) claim workflows

If your practice performs property and casualty (workers' compensation and auto injury) eBilling and receives electronic remittance advice (ERA), the AMA’s Claims Workflow Assistant tool can help you secure accurate payment from health insurers for inappropriately denied claims. Using this tool, you can look up the remark codes (i.e. CARC/RARC combination code sets) that payers place on the ERA to find out associated workflows that would address reasons for claim denial or non-payments, especially for your property and casualty (workers’ compensation and auto injury) claims. Then, you can follow the steps provided to maximize your recovery. The Claims Workflow Assistant tool also provides a number of helpful template appeal letters that AMA members can easily modify to use in their practices.

Access this resource

Workers' compensation remittance advice code combinations

Accredited Standards Committee (ASC) X12, a standards development organization for electronic information exchange that develops the electronic transaction standards, has released a Type 2 Technical Report (TR2) identifying code combinations for Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) used in workers' compensation claims, which is available for purchase through their website.

LinkedIn Discussion Group
Join discussions in the AMA Administrative Simplification LinkedIn Group.