Common Questions

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Billing

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What are the timely filing requirements for submitting a bill to WSI?

WSI requires a provider submit a medical bill for reimbursement within one year from the date of service. If a provider renders a service and WSI has either not yet made a liability decision or reverses a previous liability decision, the provider may submit a bill within one year from the date WSI accepted liability.

How do I submit a bill to WSI for payment?

A provider may submit a bill electronically or in paper format via US Mail. Refer to the Billing & Payment section for complete information.

How does WSI reimburse for a billed charge?

WSI reimburses for a medical service in accordance with the WSI Fee Schedule for both an in-state or out-of-state provider. A provider should access the applicable Fee Schedule Guideline for complete information.

How do I submit an appeal for a denial or reduction of payment?

WSI's remittance advice features reason codes which provide a detailed explanation of how WSI processed a charge, including whether a denied or reduced charge is eligible for an appeal. For a charge identified as eligible for an appeal, a provider must complete the Medical Bill Appeal (M6) form and submit it to WSI within 30 days of the remittance advice issue date. A provider should include a detailed explanation of the appeal reason and include additional supporting documentation.

Does WSI reimburse for Durable Medical Equipment (DME) products or supplies?

When prescribed by a treating provider for a condition directly related to a work injury, WSI may reimburse for DME. A provider should review WSI's DME Guide for additional information on coverage and prior authorization requirements.

Do I need to complete the Capability Assessment (C3) form at every appointment?

Yes, a capability assessment should occur at every office visit and naturally change over time. The primary treating provider may utilize WSI's C3 form or a form unique to their facility to document an injured employee's capabilities.

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Prior Authorization

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What services require prior authorization?

A service may require prior authorization from either the injured employee's Claims Adjuster or the Utilization Review department. A provider is responsible for reviewing the Utilization Review Guide to determine whether a service requires authorization. Visit the Prior Authorization section for complete information.

How long does WSI have to complete a UR request?

Upon receipt of the request and supporting documentation, WSI has three business days to complete the review. Visit the Prior Authorization section for complete information.

Can we request an extension on the timeframe for a previously approved authorization request?

If an approved surgery does not occur within 3 months (6 months for elective fusions), the request must be re-submitted with updated medical information for additional review. For chiropractic care, therapy treatment or work hardening/conditioning, a provider may request up to a 2-week extension by calling the UR department at 701-328-5990 or 888-777-5871 before the current approval expires. Visit the Prior Authorization section for complete information.

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Provider Enrollment/Registration

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How do I register with WSI?

WSI requires a Medical Provider Payee Registration form for each group/billing NPI used to bill WSI. An individual rendering provider does not need to submit a separate registration. Visit the Provider Registration section for complete details.

Do I need to register each of my practitioners with WSI?

WSI does not require a separate registration for an individual rendering provider associated with the practice.

How do I notify WSI of a change in business name, address, or other information?

A provider should submit all demographic updates to WSI by completing the Medical Provider Payee Registration form.

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Provider Resources

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Does WSI have an online portal?

The myWSI portal allows a provider to look up claim numbers and access fee schedules. A registered user may also submit utilization review forms (UR Review Request (UR-C)/UR Chiropractic Review Request (UR-Chiro) and check bill status. Click here for additional information.

Does WSI have any resources for providers to utilize?

WSI provides several resources including Quick Reference Guides, Medical Policies, etc. for providers to utilize. Click here for additional educational resources.

How do I request education from WSI?

To request a visit from WSI or discuss education opportunities, click here.