Workers' compensation information system (WCIS)

Bill and claim counts by date of injury

The WCIS uses the Jurisdiction Claim Number (JCN), Insurer Federal Employer  Identification Number FEIN and Claims Administrator Claim number to match medical bills with FROI/SROI claims. Data presented in these tables are for claims matched with a FROI/SROI claim. It does not include unmatched data.

Table 2.1 presents the count of insurers reporting data by date of injury. The WCIS collects Insurer FEIN data on each reported bill. This table is unique count of the insurer FEIN data.

Year of Injury Number of Insurers
2007 1,452
2008 1,382
2009 1,317
2010 1,209
2011 1,157
2012 1,337
2013 940
2014 811

Source: WCIS data as of June 2015

Table 2.2 shows the count of bills by type of bill. DN 503 Billing Format Code is used to classify bill types. Claim Counts are the count of unique JCN.  Professional Bills  are  bills with Billing Format code of B (Data from HCFA 1500), institutional bills are bills with Billing Format code of A (Data from UB92), and prescription bills are bills with Billing Format Code B and Billing Type code is RX (Pharmacy or Drug).

Year of Injury Claims with Professional Bills Claims with Institutional Bills Claims with Prescription Bills
2007 496,161 147,484 104,334
2008 448,733 135,699 101,740
2009 389,683 122,480 94,234
2010 320,920 96,430 83,033
2011 309,064 81,729 86,846
2012 324,806 85,466 86,009
2013 295,227 87,105 78,589
2014 329,291 87,441 72,308

Source: WCIS medical bill data as of June 2015

Table 2.3 shows the number of bills by date of injury. DN 503 Billing Format Code is used to classify bill types. Claim Counts are the count of unique JCN. Professional Bills  are  bills with Billing Format code of B (Data from HCFA 1500), institutional bills are bills with Billing Format code of A (Data from UB92), and prescription bills are bills with Billing Format Code B and Billing Type code is RX (Pharmacy or Drug).

Year of Injury Professional  Bills Institutional Bills  Prescription Bills
2007 9,022,422 516,667 1,167,679
2008 8,685,413 482,674 1,081,187
2009 8,312,541 468,852 990,362
2010 7,214,617 360,584 846,254
2011 6,231,066 252,837 702,078
2012 5,901,386 226,127 584,557
2013 4,828,434 187,561 405,322
2014 3,767,566 154,795 238,581

Source: WCIS medical bill data as of June 2015

Medical billing reports, tables and papers

August 2015