The current process….

An accident occurs…

(2-vehichles, multi-vehicle accidents)

Ambulance, police info gathering & police reports generated
Customers go to hospital to treat injuries
Billing generated

(at-fault & not-at-fault customers)

Hospital does not know who’s “at fault”…

…until police report is filed to begin billing process


Precursor to claim number being issued, or until liability is determined…….

(RCM billing service)

  • Vendor comes on-premise (possible) and begins capturing pertinent info from parties
    • Gather insurance information from patients
  • Hospital generates bill and sends to vendor
    • Vendor seeks out police reports to find out info about at-fault party holds billing until knows where to send
  • Meantime, vendor gathers supporting documents to generate billing
    • Vendor requests info from hospital client èprocesses can be manual, fax, email, sFTP file exchange, or other
  • Once vendor knows who to bill….
    • Submits billing to insurance company for payment on behalf of hospital customer

Follows process above but also…..

  • Vendor submits billing to At-Fault insurance co or injured party attorney for payment on behalf of hospital customer

There may be caveats that create medical liens…….

  • If lawsuit ensues, attorneys hired & hospital does not receiving payment until settled
  • Attorneys make request for medical bills and supporting documents (PT, DME, body shop invoices) BILLING
  • To ensure payment, hospital files medical lien 

Once medical lien case is settled…..

  • County will check to see if any liens are filed against lawsuit
  • If lien has been filed, lien holders are paid before award is issued to victim

Solutions for Auto

Hospital Client EDI Delivery to Vendors

  • Medical bills sent by providers & hospitals to WCEDI or to vendors through WCEDI Clearinghouse
  • 2-way communication through WCEDI Clearinghouse for additional supporting documents
Prospective Billing

Requesting Info from Third Parties

  • Vendor uses WCEDI systems to gather unstructured documents from third parties (lawyers, police, others):
    • Upload request
    • Upload / add recipient
    • Sends out (email, fax, letter)
    • Recipient receives (notice given to submitter)
    • Recipient responds using array of methods (upload online, fax, mailroom)
    • Vendor accesses through central doc management workflow system
Unstructured Document Aggregation

Vendor EDI Delivery to Insurance Carriers

  • Medical billing generated by provider or vendor created & sent via WCEDI to receiving insurance carriers
Retrospective Billing

EDI Clearinghouse Serrvices


Centralized Document Solution

Direct to Mail™

Submitters tasked with responding to third-party requests for documentation regarding workers compensation cases can now easily have our firm handle the processing of those non-structured document delivery.

Virtual Paper Processing (VPP) Solution

Data is presented to receiver as an “image rendition” of electronic data & supporting documents


Unstructured Document Web Portal. Helps with DEMAND PACKAGES for medical lien cases