Important Reminder for Workers' Compensation Providers

To ensure accurate and timely processing of Workers' Compensation claims, please refer to the important information below. Remember, submitting claims with incomplete or inaccurate information, or on the incorrect claim form may delay processing and payment.

We encourage each of our valued Workers' Compensation providers to post the following information where it will be easily accessible:

1. Contact the insurance payor/adjuster's office provided by the patient to verify eligibility and confirm benefit coverage.
2. Complete standard claim forms, CMS 1500 02/12 (professional) and UB-04 (facility), utilizing current CPT-4/HCPC and Revenue Code (ICD-10) Guidelines.
3. In addition to all required fields on the claim form, all Workers' Compensation claims must include:
• Employer;
• Itemized charges for service(s) rendered (charges should reflect the actual fee for the service described);
• Identify if the patient's condition is related to a) Employment b) Auto Accident c) Other Accident;
• Description and office/operative notes for any "unlisted service" and a copy of operative notes for any surgical procedure.

For questions, please contact your Provider Relationship Account Manager . Thank you for your participation in our networks and for the care you provide your patients and our members.