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Good Morning
4:37:37 AM CDT
Saturday, April 19, 2014

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Billings, Medical Payments, and Fee Schedules

Topics Provider Remittance Advice Forms & Publications E/M Documentation Guidelines
Billing and Medical Payments Reconsideration of Billed Charges Explanation of Benefits (EOB) Codes  
Bill Review Department Billing Options Provider Request for Adjustment (M6)  
Payment Delays Fee Schedule Information Fee Schedules  
Advanced Beneficiary Notice of Non-Payment (ABN)   Advanced Beneficiary Notice (ABN)  

Bill Review Department
The WSI bill review department employees Certified Professional Coders and follows AMA guidelines for coding. Medical bills are down-coded or denied if appropriate documentation is not submitted supporting the level of code billed. North Dakota Administrative rule requires submission of medical documentation along with the billed charge. Bills are reviewed for:

  • Proper billing of services
  • Medical relatedness and necessity to the accepted injury
  • Associated medical records
  • Actual delivery of billed services
  • Accuracy of charges and codes

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