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Good Evening
11:09:05 PM CDT
Wednesday, April 16, 2014

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Medical Providers Section Header Medical Providers Logo

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)  

Provider Remittance Advice
Remittances are sent weekly with the reimbursement check. The remittance advice includes:

  • Patient's name, date of service, procedure billed, submitted amount, and paid amount
  • Reason codes or Explanation of Benefits (EOB) codes, explain reductions in payment of a service or denial of payment.
    • Some EOB codes allow the patient to be billed for the denied charges, or for the balance of reduced charges. These instances are identified by the statement "CONTACT CLAIMANT FOR PAYMENT". When these EOB codes occur, WSI also sends a "NOTICE OF NON-PAYMENT" EOB to the patient regarding the reduced or denied charges, to inform the patient of their responsibility for the charges.
  • If an EOB code does not state the patient may be contacted for payment, any reduction or denial of services is not billable to the patient, the employer, or another insurer.

To access the complete descriptions of the Explanation of Benefits (EOB) Codes.

To receive periodic electronic updates from WSI please visit Medical Provider News Section at www.workforcesafety.com