Things You'll Need:
- Date of Injury
- Employer Name, Address, Phone Number where injury occurred
- Workers Comp Name, Address, Phone Number, Claim Number
- Patient Social Security Number
- LIBC-9
- LIBC 507
- Itemized Bill
- HCFA (for professionals)
- UB (for facilities)
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Step 1
When a patient first presents stating they suffered a work injury, you must get some crucial information from them. Ask them for their employers name, address, and phone number. Next ask for the workers compensation carrier' s name, address, phone number. You will also need the claim number and the date of injury.
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Step 2
After the patient has been seen by the physician and a HCFA or UB has been created you need to fill out an LIBC-9. Remember this is a two sided form even though you are only filling in one side! Then mail the bill, LIBC-9, itemized bill, and medical records to the comp carrier.
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Step 3
In Pennsylvania worker compensation carriers have 30 days + 6 days for mailing to respond to a billing. They can respond in one of three ways. 1. Reimbursement in accordance with the fee schedule (this can be found at a link below) 2. Denial 3. Notice of utilization review. **If response is late, compensation carriers have to pay 10% annum interest**
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Step 4
If the carrier does not respond in the allotted amount of time, you disagree with a denial, or a payment amount is incorrect you can then file a fee review. Fee reviews must be filed within 90 days of the original bill date or 30 days after a denial or disputed payment is received.
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Step 5
To file a fee review you must fill out a LIBC-507 and send with a copy of the original bill, itemized bill, LIBC-9 (with original bill date) and medical records. Include a summary of why you are filing the review. Send a copy of the packet to the compensation carrier and keep a copy for your records. The original gets mailed to the Bureau of Workers Compensation. They will notify you of a decision in a few months.
