Workers' compensation is insurance that provides cash benefits and/or medical care for workers who are injured or become ill as a direct result of their job.
Employers pay for this insurance, and may not require the employee to contribute to the cost of compensation. Weekly cash benefits and medical care are paid by the employer's insurance carrier, as directed by the Workers' Compensation Board. The Workers' Compensation Board is a state agency that processes the claims and determines, through a judicial proceeding, whether a worker will receive benefits and/or medical care, and how much he/she will receive.
In a workers' compensation case, no one party is determined to be at fault. The amount that a claimant receives is not decreased by his/her carelessness, nor increased by an employer's fault. However, a worker loses his/her right to workers' compensation if the injury results solely from his/her intoxication from drugs or alcohol, or from the intent to injure him/herself or someone else.
A claim is paid if the employer or insurance carrier agrees that the injury or illness is work-related. If the employer or insurance carrier disputes the claim, no cash benefits are paid until the Workers' Compensation Law Judge decides who is right. If a worker is not receiving benefits because the employer or insurance carrier is arguing that the injury is not job-related, he/she may be eligible for Disability Benefits in the meantime. Any payments made under the Disability Program, however, will be subtracted from future workers' compensation awards.
Electronic Submission to the Workers’ Compensation Board
The Workers Compensation claims process in New York State is characterized by the large number of paper forms involved. XML Forms Submission provides an infrastructure for submission of data to the Workers' Compensation Board in an industry-standard format (XML-Extensible Markup Language).
Tranquilmoney partnered with the Board in this pilot program and came out successful in February 2007, proving its technical capabilities to submit claims in XML format, complying with the Board’s requirements.
Workers’ Compensation Billing Services
Tranquilmoney offers a complete solution for New York Worker’s Compensation Claims. We take care of the entire revenue cycle management that include charge entry, electronic and manual claims submission, claims tracking and verification, AR follow up, payment posting and patient billing.
Data is captured from super bills and charges are entered, with quality checks to ensure correct codes and modifiers.
Claims are submitted to the three entities
- Insurance Company - Claims are submitted to the insurance company in the C-4 format prescribed by the Workers’ Compensation Board.
- Worker’s Compensation Board - Claims are submitted electronically to the Board in batch mode in XML format.
- Attorney - Claims are also mailed out to attorneys. This helps the attorneys during the hearings, scheduled by the board.
AR Follow Up:
Tranquilmoney files HP1A for all pending claims with no response in 45 days. The Board typically responds to a correctly filed HP1A with an HP2. This is followed by an HP3 in case of a denial and an HP3.1 in case of a payment notification. In the event that there is no response in the form of an HP3 or HP3.1 within 7 days, Tranquilmoney files an HPJ1 as prescribed by the Board. Tranquilmoney analysts meticulously track each open claim through this AR cycle until it is paid. Dedicated executives call payers/the Board to get updates on status of claims that are scheduled for hearing. We review notices of decision (NOD) and act on those favoring the provider to expedite payment. PracticeTracker™ provides easy access to the data and documents to the provider.
Once remittance advices are received and checks are deposited, we close the cycle by posting the cash and update you.
We capture data from denial EOBs and act on those that require follow up.
On valid denials, the balance is transferred to the patient and statements are issued and mailed for payment.
PracticeTracker™ is designed to store images of patient documents linked to the patient and injury in secure locations and is accessible at the click of a button by authorized personnel. These include not just the forms that are generated by PracticeTracker™ but all documents such as insurance card, old medical records, doctor's notes, EOB’s, checks, HP2, HP3, HP3.1, NOD, C8.1, IME, etc.
PracticeTracker™ allows you to see the collection status at any time for each claim, payer or patient. We also send periodic status reports that include AR summaries, claim tracking reports, AR Aging. We even do predictive analysis to estimate your cash position for a particular week.
Improvement in collections of up to 50%
Reduced AR days
Custom reports that allow sound decision making
Easy access to your data and documents
Lower total cost of ownership
The only approved vendor for electronic submission to the NY State Workers’ Compensation Board
Expertise in workers’ compensation revenue cycle management
Management using metrics
Software specialized for workers’ compensation billing requirements
Document management system that integrates well with the billing system