This information is a resource to use in conjunction with Provider News, the Utilization Review Guide and other publications. It is subject to change at any given time without notice. Coverage decisions are subject to claims decisions, fee schedule guidelines, and applicable state laws. Information contained in this section does not constitute authorization of services.
Prior to reimbursement for treatment, providers are required to register with WSI. To register, complete the Payee Registration and Substitute W-9 form.
Processing of medical bills includes assessment of the following:
- Timely filing
- Within 1 year from date of service, or
- Within 1 year from date liability was accepted
- Medical relatedness and necessity to the accepted injury
- Medical documentation support of the billed charge
- Accuracy of charges, codes and modifiers
Providers must bill WSI for all health care services provided on or after October 1, 2015 with ICD-10 diagnosis and procedure codes. WSI will continue to accept ICD-9 for health care services provided before October 1, 2015 after implementation of ICD-10. Below is information regarding to how to handle bills that span the ICD-10 implementation date
Inpatient/DRG Charges – bill inpatient charges with date of discharge on or after October 1, 2015, with the date of discharge and utilize the ICD-10 codes. Do not split inpatient claims by date of service and do not include both ICD-9 and ICD-10 codes on a single bill.
Professional/Outpatient/DMEPOS Charges – bill charges prior to October 1, 2015 separately and utilize ICD-9 codes; bill services on or after October 1, 2015 separately and utilize ICD-10 codes. WSI will not accept bills with both ICD-9 and ICD-10 codes.
Anesthesia Charges – bill charges with dates that span and end on or after October 1, 2015, by utilizing the end date and with the ICD-10 codes.