If you are new to Workforce Safety & Insurance, this page outlines what you need to know to begin working with WSI, including registration, billing, and prior authorization.
Provider Registration
Prior to receiving reimbursement, a provider must complete a Medical Provider Payee Registration form for each group/billing National Provider Identifier (NPI) used to bill WSI. WSI sets up a single medical provider payee account for each group/billing NPI, regardless of the number of service locations sharing it.
Primary Treating Provider
An injured employee may only have one primary treating provider. WSI considers the following types of practitioners eligible to be a primary treating provider: MD, DO, APRN, PA, DC, DPM, OD, DDS, DMD, or PT. The primary treating provider manages:
- Capability assessment: A treating provider must document an injured employee’s abilities at each visit. The Capability Assessment (C3) form is a useful tool for this documentation. The injured employee should receive a copy of the C3 form to give to their employer to assist in job accommodation decisions.
- Maximum Medical Improvement (MMI): MMI is the point at which the injury will no longer improve with continued care. WSI relies on the primary treating provider's accurate and timely designation of MMI to guide claim management.
- Referral: A primary treating provider may refer an injured employee for evaluation and/or treatment with another specialty (except mental health) without prior authorization from WSI.
The myWSI online portal is an easy, fast, and secure way medical providers connect with WSI. A provider can:
- 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
- Access documents regarding prior authorization, billing, or medical records
- Upload medical records
- Verify and update demographic information
Services may require prior authorization from either the claims adjuster or Utilization Review (UR) department as outlined in the Prior Authorization Guide. Failure to obtain prior authorization will result in WSI denying reimbursement for the service. Prior authorization approval is not a guarantee of payment, as final liability and payment decisions are the responsibility of the claims adjuster managing the claim.
A provider must submit the prior authorization request in myWSI or via paper.
Fee Schedule
A provider should review the WSI Fee Schedule for information on reimbursement rates. For pricing methodology, payment parameters, billing requirements and reimbursement procedures, a provider may review the Fee Schedule Guidelines.
Billing
WSI accepts medical bills by Electronic Data Interchange (EDI) through Carisk Intelligent Clearinghouse. To establish a direct EDI connection, contact Carisk by email at [email protected] or by phone at 888-238-4792. If a practice currently uses a clearinghouse other than Carisk, contact that clearinghouse to check if an indirect connection can be established.
Bill Audit
WSI performs a prepayment audit of all medical bills and requires medical documentation to support each charge. For additional information, refer to WSI's Treatment and Documentation Policies.
Bill Appeal
To appeal a denied or reduced charge, either submit the appeal in myWSI or submit a Medical Bill Appeal (M6) form along with information supporting the reason for appeal.
Quick links and tools to support your work with WSI.
- Claim Lookup
- Prior Authorization Guide
- Durable Medical Equipment (DME) Guide
- How to Read the WSI Remittance Advice
- Remittance Advice Reason Codes
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