The current process….

An accident occurs…

(2-vehichles, multi-vehicle accidents)

1
Ambulance, police info gathering & police reports generated
Customers go to hospital to treat injuries
2
Billing generated

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

3
Hospital does not know who’s “at fault”…

…until police report is filed to begin billing process

4

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

FIRST PARTY
(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

THIRD PARTY
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

IMSLink™

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

dtmEDI™

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