WSI requires a medical provider submit a bill for reimbursement within one year from the date of service. If a medical provider renders a service and 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. 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 medical provider may submit a bill electronically through Carisk Intelligent Clearinghouse. Refer to the Billing & Payment section for complete information.
B&E stands for Benefits and Eligibility, which is a validation edit on submitted bills. The most common reasons for failing the validation is an incorrect WSI claim number or an incorrect date of injury (must be +/- 3 days to pass validation).
If you cannot determine what caused the error, contact firstname.lastname@example.org for assistance. You will need to provide the WSI claim number, date of service, billed amount, and the last date of submission.
No, there is not a specific timeframe for payment. WSI’s administrative rules on reimbursement are found in the North Dakota Administrative Code Title 92. Section 92-01-02-45 states payment shall be made “as soon as reasonably possible”.
The turnaround time for processing a bill is generally 3-4 weeks.
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 medical provider must complete the Medical Bill Appeal (M6) form and submit it to WSI within 30 days of the remittance advice issue date. A medical 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 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 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 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 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 does not require a separate registration for an individual rendering provider associated with the practice.