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eClaims - Worker's Compensation Claims

This article can be used in unison with any of the Professional templates to include pertinent information for Worker's Compensation Payers. 

Note: Entering this information in MacPractice does not ensure that your claims will be paid. Additional enrollment and/or testing may be required for these payers.

Insurance Reference

When setting up worker's comp payers, besides paying attention to the differing payer IDs, you will also want to make sure the plan type is set to 'Worker's Compensation'. This will ensure the claim is sent as a W.C. Professional claim, and not a generic Professional claim. Having this set incorrectly can cause the claim to reject.


Patient Ability

When filling out information on patient and primary tabs, this information can vary based on the payer. MOST companies would like to see the Employer listed on the claim with the patient being listed as the Employee. To be sure of how this needs to reflect on the claim, the office should contact the payer for submission requirements.

On the Primary/Secondary Tab, enter the employer with the employer's Worker's Compensation Insurance. There is an 'Employers' section in the middle third of the Primary/Secondary Tab of the Patients Ability.

On the Patient Tab, be sure the patient listed is the employee for the aforementioned employer. The relationship to primary/secondary will need to be set to 'Employee'. In addition to setting the relationship, the Patient's Social Security Number will need to be entered in the Social Security Number field, as it is required for all Worker's Compensation claims. 

When on the Ledger Tab, there are a few important areas of the Incident that will need to be filled out for use with Worker's Compensation Claims.

  • Incident > Claims > Disability > Last Work Date - This will pull into the claim to inform the insurance company of the date the employee last worked.
  • Incident > Resource Tab - Clicking the green plus (+) button will add a new resource to the incident, so that important documentation can be listed on the claim
    • Note: Currently we do not have an integrated solution in MacPractice to submit electronic attachments for worker’s compensation claims. Any paperwork will need to be emailed, mailed or faxed to the payer. Please contact the payer to determine how they would like to receive paperwork. MacPractice does have an option available to submit attachments via Change Healthcare Portal, please contact the enrollment department for more information. This option is for Workman's Compensation claims ONLY.
    • Enter the following information to submit a paperwork segment on a worker's compensation eClaim.
      • Attachment Control Number - This will be a number assigned by the payer to submit on the claim, usually for internal tracking purposes for the insurance company.
      • Attachment Transmission Code - This will tell the payer how the attachment was transmitted, either by mail, secure email, fax, electronically only or available upon request*.
      • Attachment Type Code - This will the the payer what type of attachment you are sending, either support data for verification, admission summary, prescription, physician order, referral form, certification, and so forth.

*If 'Available Upon Request' is selected for the transmission code, leave the other two resource fields blank.

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