Common Questions

Billing

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

WSI requires a provider to submit a medical bill to WSI for reimbursement within one year from the date of service. In circumstances where a service has been rendered and WSI has either not yet made a liability decision or WSI reverses a previous liability decision, a 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 billed charges to WSI 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 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 reimbursement for Duable 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?

A capability assessment should be done 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 worker's capabilities.

Prior Authorization

What services require prior authorization?

WSI may require prior authorization for a service from either the injured worker's claim 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 the authorization is not utilized within three months (six months for elective fusions), the request must be re-submitted with updated medical information for additional review. To request an extension on the timeframe, call the UR department at 701-328-5990 or 888-777-5871. Visit the Prior Authorization section for complete information.

Provider Enrollment/Registration

How do I register my business with WSI?

WSI requires a business submit a Medical Provider Payee Registration form for each billing NPI used to submit charges to WSI. Visit the Provider Registration section for complete details.

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

WSI does not require a business to submit registration for the individual rendering providers associated with the business.

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

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

Provider Resources

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.