e-billing

California is one of the first three states in the country to provide for e-billing in workers’ compensation. The DWC has adopted new regulations for standardized paper billing forms and e-billing standards, which encourage both workers’ compensation insurers and medical providers to transition to e-billing. Implementation of e-billing will improve efficiency of the billing and remittance process and produce quicker bill payment.

Provisions relating to e-billing became effective Oct. 18, 2012. By statute, claims administrators are required to accept electronic bills and may develop their own capacity to accept electronic bills or may contract with a vendor to perform the function. Participation in e-billing is optional for medical providers.

Medical providers – including hospitals, doctors, pharmacists, and others who provide medical services and goods to injured workers – are increasingly recognizing the benefits of using electronic standards to send their bills to payers. In turn, claims administrators who complete the cycle by processing and paying those bills electronically are seeing efficiencies from streamlined processes.

Electronic billing regulations and guides

Effective Jan. 1, 2013:

• E-billing regulations; independent bill review regulations version version
• California Division of Workers’ Compensation Medical Billing and Payment Guide
• California Division of Workers’ Compensation Electronic Medical Billing and Payment Companion Guide version version

Note: The regulations and guides effective Jan. 1, 2013 were adopted as emergency regulations. A formal rulemaking action is currently underway to adopt the emergency regulations and to make additional amendments. You may learn how to participate in the rulemaking action and view the rulemaking documents on the Division’s rulemaking web page. The Division welcomes public comment and suggestions on how to make improvements to the billing regulations.

Effective Oct. 18, 2012:

• E-billing regulations - sections 9792.5.0 - 9792.5.3
• Medical Billing and Payment Guide 2011
• Excerpt of Medical Billing and Payment Guide - Table 1.0 California DWC Bill Adjustment Reason Code / CARC / RARC Matrix Crosswalk and Table 2.0 Matrix List in CARC Order versionversion
• Electronic Medical Billing and Payment Companion Guide 2012

Resources

• Frequently asked questions about e-billing
• Introduction to electronic medical billing / bill processing service providers

What's New

March 2013