The current process….
(2-vehichles, multi-vehicle accidents)
Customers go to hospital to treat injuries
(at-fault & not-at-fault customers)
…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
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
Vendor EDI Delivery to Insurance Carriers
- Medical billing generated by provider or vendor created & sent via WCEDI to receiving insurance carriers