Workers' compensation information system (WCIS)

Bill and Claim counts by Date Insurer Paid Bill

The WCIS uses the JCN, Insurer 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 3.1 presents the count of insurers reporting data by date insurer paid bill. 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 1,137
2008 1,133
2009 1,344
2010 1,280
2011 1,063
2012 1,670
2013 1,521
2014 1,256

Source: WCIS data as of June 2015

Table 3.2 shows the count of bills by type of bill. DN 0503 Billing Format Code is used to classify bill types. 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). Claim counts are the count of unique JCNs.

Year of Injury Claims with Professional Bills Claims with Institutional Bills Claims with Prescription Bills
2007 819,167 164,506 185,704
2008 911,932 192,058 198,662
2009 862,562 186,026 206,294
2010 775,819 187,456 202,381
2011 700,313 158,409 206,264
2012 754,588 155,365 208,740
2013 740,223 167,069 213,893
2014 754,759 165,171 187,424

Source: WCIS medical bill data as of June 2015

Table 3.3 shows the number of bills by date of insurer paid bill. DN 0503 Billing Format Code is used to classify bill types. 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 7,183,976 381,971 1,094,942
2008 8,041,726 403,276 1,149,184
2009 7,940,015 359,209 1,237,258
2010 8,824,421 528,103 1,425,639
2011 8,452,096 502,686 1,436,128
2012 9,175,348 504,851 1,548,731
2013 9,962,305 433,928 1,815,637
2014 8,764,964 332,951 1,180,651

Source: WCIS medical bill data as of June 2015

Medical billing reports, tables and papers

August 2015