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Second – If employer has already submitted Injury to board than we don’t have to worry about it, we can simply initial C4 to WC board thru Fax, Online Submission or thru Mail. Most Practices send Claim form thru mail which takes time to process,
There is another way to send initial submission thru Fax, which would be very easy and convenient : http://www.wcb.ny.gov/content/main/forms/Howtofax.jsp and very easy submission is thru their online portal : http://www.wcb.ny.gov/content/ebiz/WEBForms/webform_HCProvider.jsp#c4 ( User name and Pass Required)
Am Not going to talk about CODING because there are many factors related to surgery, LCD NCD NCCI edits and Coverage. When surgeon was assistant in surgery than most of the Time I use 80 81 82 and AS modifier based on above factors.
I am not saying that he/she can’t do this, they can. Some insurance process a certain claim separately for Different provider But some do not. I don’t want to say their name, but surgeons already know that which insurance is a Pain in the neck.
Carrier may deny claim saying Duplicate or saying – there is one more claim for the same patient which is already processed hence cannot process this one (they have processed this claim for Primary Surgeon)
Now, what can we do here?
We can use different envelope. In the second envelop we can send a Letter stating that this claim is for Assistant in surgery.
Sometime I send license copy of assistant surgeon along with the letter, doing this my claims denial reduced to 40%.
Many providers do not know that claims can be send Electronically, some EMR/EHR does have these capability. And you can send OP/Medical notes electronically as well. This will definitely expedite reimbursement.
Some Clerks might wanna send claim thru Fax. You can do it, But, not when DOS is not 45 days old.
My suggestion is to get in touch with Carrier and can ask for privilege for sending fax for claim submission for newer DOS instead of submitting Claim thru Mail or thru Electronic format.
Currently I am sending Fax to some carrier after taking permission. You can also do that by paying some additional fee to your responsible carrier.
I have not covered claims denials and working with WC Board and Carrier because different cases have different terms.
Have Any suggestion ……:) !
The process for filing a workers’ comp claim varies from state to state, but nearly always involves an employer, the injured employee, an insurance provider, and medical professionals.
More serious cases include diseases caused by exposure to hazards, such as benzene, asbestos or silica dust. While mesothelioma is one extreme example of this, a more common example is rashes brought on by exposure to cleaning chemicals or gasoline.
Workers’ compensation typically doesn’t cover injuries resulting from horseplay at work, or injuries sustained while drunk or in an impaired state. Likewise, only a few states provide coverage for employees injured while travelling to and from work, unless that transportation is provided by the employer.
The vast majority of workers’ compensation cases are streamlined, and only involve filing a claim with the workers’comp insurance carrier. But there are times when it’s necessary to hire a attorney due to coverage limits or denial of benefits.
An issue in all states concerns the plight of temporary workers. Temp workers usually are treated as second-class citizens regarding their rights to training, safety measures and the collection of worker compensation benefits. Temp workers in New York City are often in the nonunion sector where workers are injured more often due to a lack of training and lesser safety protections.
The problem is that temp workers are not employed by the company where they are sent to work. The worker actually remains an employee of the employment agency. Thus, workers’ compensation premiums and unemployment compensation are paid for and managed by the temp agency.
There is a basic disconnect in such a system. At work, the temp worker is not viewed as an employee of the company and is not given training necessary to foster a stronger safety net and more proactive self-protections by the worker. This fact, documented by many studies, results in a higher percentage of work accidents to temporary workers.
The temporary workers are protected by the workers’ compensation system. This insurance coverage is purchased by the temp agency to cover its temp workers for accidents suffered while working at a temp assignment. A higher percentage of claims filed by temp workers are denied by the workers’ compensation insurance carriers. This may be due to a lesser sense of responsibility felt by insurers toward workers who may be there one day and gone the next.
New York City struggles with temporary worker problems similar to what is found in other population centers. In areas with a prevalence of industrial plants, factories, construction sites and warehouses, there will be a higher number of temp workers. Temp workers should complain to the employment agency when they are exposed to unsafe conditions or not given training. When the temp worker is given the “run around” about filing a workers’ compensation claim form, that is the sign to immediately obtain a free consultation with an experienced workers’ compensation attorney to assure protection of one’s legal rights.
1. If you : Are covered by Medicare and Medicaid
Situation : Entitled to Medicare and Medicaid
Pays first : Medicare
Pays second : Medicaid
2. If you : Are 65 or older and covered by a group health plan because you or your spouse is still working
Situation : A. Entitled to Medicare //// B. The employer has 20 or more employees /// C. The employer has less than 20 employees
Pays first : A Group health plan /// B. Medicare
Pays second : A. Medicare /// B. Group health plan
3. If you : Have an employer group health plan through your former employer after you retire and are 65 or older
Situation : Entitled to Medicare
Pays second : Medicare
4. If you : Are disabled and covered by a large group health plan from your work, or from a family member (like spouse, domestic partner, son, daughter, or grandchild) who’s working
Situation : A. Entitled to Medicare /// B. The employer has 100 or more employees /// C. The employer has less than 100 employees
Pays first : A. Large group health plan /// B. Medicare
5. If you : *Have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) and group health plan coverage (including a retirement plan)
Situation : A. First 30 months of eligibility or entitlement to Medicare /// B. After 30 months of eligibility or entitlement to Medicare
Pays first : A. Group health plan /// B. Medicare
6. If you : Have ESRD and COBRA coverage
Situation : A. First 30 months of eligibility or entitlement to Medicare based on having ESRD /// B. After 30 months
Pays first : A. COBRA /// B. Medicare
Pays second : A. Medicare /// B. COBRA
7. If you : Are 65 or over OR disabled (other than by ESRD) and covered by Medicare and COBRA coverage
Pays second :COBRA
8. If you : Have been in an accident where no-fault or liability insurance is involved
Pays first : No-fault or liability insurance for services or items related to accident claim
9. If you : Are covered under workers’ compensation because of a job‑related illness or injury
Pays first : Workers’ compensation for services or items related to workers’ compensation claim
Pays second : Usually doesn’t apply. However, Medicare may make a conditional payment (a payment that must be repaid to Medicare when a settlement, judgment, ward, or other payment is made.)
10. If you : Are a Veteran and have Veterans’ benefits
Situation : Entitled to Medicare and Veterans’ benefits
Pays first : Medicare pays for Medicare-covered services or items.
Veterans’ Affairs pays for VA-authorized services or items.
Note: Generally, Medicare and VA can’t pay for the same service or items.
Pays second : Usually doesn’t apply
11. If you : Are covered under TRICARE
Situation : Entitled to Medicare and TRICARE
Pays first : Medicare pays for Medicare-covered services or items. TRICARE pays for services or items from a military hospital or any other federal provider.
Pays second : TRICARE may pay second.
12. If you : Have black lung disease and are covered under the Federal Black Lung Benefits Program
Situation : Entitled to Medicare and the Federal Black Lung Benefits Program
Pays first : The Federal Black Lung Benefits Program for services related to black lung.
Generally, no. It’s against the law for someone who knows that you have Medicare
to sell or issue you a Marketplace policy. This is true even if you have only
Medicare Part A or only Medicare Part B. Therefore, if you already have Medicare, you shouldn’t need to coordinate benefits between Medicare and a Marketplace plan. On the other hand, if you don’t yet have Medicare but have coverage through the Marketplace, you can choose to keep your Marketplace plan after your Medicare coverage starts. But, if you’ve been getting premium tax credits or other savings on a plan you bough through the Marketplace, these savings will end once your Part A coverage starts, so you’d have to pay full price for the Marketplace plan. If you age into Medicare and decide to keep your Marketplace plan, then Medicare pays first. Where can I get more information about who pays first? Call your health insurance plan’s benefits administrator. You can also call the
Benefits Coordination & Recovery Center (BCRC) toll-free at 1-855‑798‑2627.
TTY users should call 1-855-797-2627..
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