Billings and Medical Payments

To help ensure timely and appropriate payment, please follow these guidelines:

1. Bill on the appropriate form.
2. Attach supporting documentation to the bill.
3. List the name of the injured worker, the claim number if you have it, the employer, and the date of the injury.
4. Provide the usual charge for services provided.
5. List the code for the procedure and a description of the services.
6. List the number of visits, the date of each visit, and the procedures followed in any treatment administered during the visit.
7. Provide codes for supplies and materials provided or administered to the injured worker.
8. Supply the federal tax identification number of the healthcare provider.
9. Provide the signature of the person who provided the service.
10. List the ICD-9-CM codes identifying the injured worker's body part(s) that were affected by the injury.
11. Include the UPIN number when submitting bills through electronic data interchange (EDI).
12. Submit bill within one year of the date of service or within one year of the date WSI accepts liability for the work injury or condition.

What is the turnaround time for WSI to pay a medical provider once a bill has been submitted?

Typically, 30 days. We are continually looking for new ways in which to provide a quicker turnaround time.

What factors cause a delay in receiving a timely medical payment from WSI?

1. Complicated issues associated with the decision of claim acceptance or denial
2. Investigation of liability for a specific treatment or condition
3. Lack of necessary medical documentation or medical notes
4. Prior authorization issues
5. Incomplete or inaccurate medical bills
6. Further review of documentation
7. Disputed issues on the claim

How can I appeal a billing or payment issue?

You can appeal a billing or payment issue by writing us within 30 days from the date of the letter you receive which states that a certain billing or portion of a billing is being denied for payment by us. See listing of Explanation of Benefit (EOB) Codes.

How long do I have to submit a bill to WSI for services provided to an injured worker?

HCFA's and UB's must be submitted within one year of the date of service or within one year of the date WSI accepts liability for the work injury or condition.

Can I bill an injured worker for charges?

You can only bill the injured worker for charges when you receive an Explanation of Benefits form that states the claim has been denied by WSI or the services were unrelated to the injury.

Who is responsible for payment on a denied claim?

The injured worker is responsible for payment or ensuring payment on a denied claim.

Options for Electronic Data Interchange (EDI) submission:

Listed below are the three Electronic Data Interchange (EDI) options statewide providers have to electronically submit medical bills to WSI:

1. WSI has been working with P2P Link to allow medical providers the option of electronically submitting their medical bills, along with the required documentation. To learn more about P2P Link, visit their web site at www.P2PLink.com.
2. WSI is also working with Blue Cross Blue Shield of North Dakota (BCBSND) to allow providers the option of submitting their medical bills utilizing BCBSND's PC-ACE software. You can access BCBSND's web site at www.bcbsnd.com to learn more about PC-ACE.
3. Providers that have selected to use other software or clearing-house products to submit their charges electronically to BCBSND can also use that process to submit medical charges to WSI.

For questions on how to get set up using EDI, please contact Marsha Buchwitz at (701)-328-5973 or toll-free at 1-800-440-3796, Ext. 85973# or by email at mbuchwitz@nd.gov.

What is the importance of a UPIN number?

We use this as an identifier, and it helps avoid delays in the reimbursement of EDI bills.

Do I need a provider number to do business with WSI?

We do not assign provider numbers; instead, we use your UPIN and your federal tax identification number.