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.
No. A claim does not need to be accepted by WSI in order to submit a medical bill; however, the claim does need to be filed with WSI, as the claim number is a necessary component of billing.
A provider may submit a bill electronically or in paper format via US Mail. Refer to the Billing & Payment section for complete information.
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.
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.
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.
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.
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 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.
WSI does not require a separate registration for an individual rendering provider associated with the practice.