Common Questions

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

No. WSI does not need to accept a claim before a medical provider may submit a medical bill. 

A medical provider may submit a bill electronically through Carisk Intelligent Clearinghouse. Refer to the Billing & Payment section for complete information.

B&E is an abbreviation for Benefits and Eligibility, which is a validation edit on submitted bills. The most common reasons for failing the validation are an incorrect WSI claim number or an incorrect date of injury (must be +/- 3 days to pass validation). 

If needed, a medical provider may contact [email protected] to obtain assistance with determining the source of an error. 

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

No, there is not a specific timeframe for payment. Section 92-01-02-45 of the North Dakota Administrative Code states payment shall be made “as soon as reasonably possible”. 

The average turnaround time for processing a bill is 3-4 weeks. 

The reason codes in WSI's remittance advice 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 medical provider must submit an appeal within 30 days from the date of the remittance advice by completing the Medical Bill Appeal (M6) form or online in myWSI. A medical provider should include a detailed explanation of the appeal reason and additional supporting documentation.

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

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

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

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.

If an approved surgery does not occur within 3 months (6 months for elective fusions), the medical provider must resubmit the request with updated medical information. For chiropractic care, therapy treatment, or work hardening/conditioning, a medical 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.

WSI requires a medical provider complete 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.

No, WSI does not require a separate registration for an individual rendering provider associated with the practice.

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

Yes. The myWSI portal allows a registered provider to:

• Review bill status and processing information
• Obtain a remittance advice
• Submit a bill appeal
• Generate an overpayment recovery report
• Submit or appeal a prior authorization request
• Track the WSI response
• Access letters WSI has sent to the practice regarding prior authorization, billing, or medical records
• Respond to a WSI medical records request
• Verify and update demographic information

For more information visit the myWSI Support Center | North Dakota Workforce Safety & Insurance.

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