Claim Verification
When a new injured worker presents at the hospital and the staff captures pertinent patient, employer, and injury information, it is transmitted electronically to UHS. UHS will verify the claim’s compensability with the employer, determine where bills should be submitted, and contact the work comp carrier to confirm an injury claim has been reported. The hospital is notified immediately if an injury claim is denied as not work-related by an employer or an adjuster.
Treatment Authorization
When the hospital receives a treatment order requiring prior authorization, a copy of the order will be sent to UHS to obtain approval for the scheduled services. When authorization is obtained, UHS will immediately notify the hospital and forward documentation of the adjuster’s authorization. UHS will update the hospital daily on pending treatment requests. UHS will expedite its processes to secure authorization for STAT procedures as quickly as possible.
Billing
After the patient is discharged, the hospital will bill and charge files will be electronically transmitted to UHS. UHS will obtain medical records and IBs and any other documentation needed to support billed charges. UHS will generate the UB and submit it, along with medical records and itemized statements, to the correct payer address.
Collections and Reimbursement
UHS will contact payers after bills have been submitted to confirm they are being processed for payment. When payment is received, UHS will review EOB payments against contracts and state workers’ compensation fee schedules, UHS will submit reconsiderations on all bills that are not paid correctly and will continue collection procedures until full payment is received.
Copyright © 2023 Unified Health Services. All Rights Reserved.