When a newly injured worker is scheduled at the clinic 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 clinic is notified immediately if an injury claim is denied as not work-related by an employer or an adjuster.
When the clinic provider writes an order for further treatment which will require 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 clinic and forward documentation of the adjuster’s authorization. UHS will update the clinic daily on pending treatment requests. UHS will expedite its processes to secure authorization for STAT procedures as quickly as possible.
After the office notes have been coded and charges entered, the clinic will electronically transmit the charge file to UHS. UHS will obtain notes and reports needed to support billed charges. UHS will generate the HCFA and submit it, along with medical documentation to the correct payer address.
UHS will contact payers after bills have been submitted to confirm the invoices are being processed for payment. UHS will quickly resolve any deficiencies noted by the payer. When payment is received, UHS will review EOB payments against state workers’ compensation fee schedules, PPO contracts, and Employer Agreements. UHS will submit reconsiderations on all bills that are not paid correctly and will continue collection processes until full payment is received.