Workers' compensation information system (WCIS)

Bill and Claim counts by Date of Service

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 4.1 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 JCN. 

Year of Injury Claims with Professional
 Bills
Claims with Institutional
Bills
Claims with Prescription
Bills
<2006 74,688 5,376 8,100
2006 438,937 68,282 34,288
2007 840,004 186,242 50,542
2008 803,594 183,172 60,156
2009 744,032 174,087 66,397
2010 651,212 165,859 65,149
2011 595,318 133,628 72,719
2012 588,377 129,634 65,765
2013 632,347 148,972 72,978
2014 658,231 149,628 65,055

Source: WCIS data as of June 2015

Table 4.2 shows the count of bills by type of bill and date of service. 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
<2006 274,088 10,242 38,033
2006 2,630,509 132,290 182,334
2007 8,421,956 459,645 215,162
2008 8,232,525 396,194 266,234
2009 8,525,305 397,754 341,863
2010 8,617,513 513,265 399,263
2011 7,674,071 423,264 444,087
2012 7,288,518 386,331 401,564
2013 9,095,915 362,388 507,949
2014 7,934,332 301,765 360,625

Source: WCIS medical bill data as of June 2015

Medical billing reports, tables and papers

August 2015