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Creating Worker's Comp Paper Claims in MacPractice

This article seeks to give some basic assistance on how to create Worker's Compensation Paper Claims in MacPractice. If you utilize eClaims, you'll want to refer to the eClaims article about Worker's Comp Claims instead.

Warning: While we've done our best to provide a general idea of what is needed, each insurance company has different requirements for how worker's comp claims are handled. Regardless of any instructions given here, you will have to work with the payer to determine how they want worker's comp claims to be submitted.

MacPractice Support is available to assist with ensuring particular information is included or formatted properly, but we cannot assist with determining what is required on a particular claim.

Insurance Reference
When setting up worker's comp insurance companies or specific plans, you will want to make sure the plan type is set to 'Worker's Compensation'. This will ensure that the Worker's Comp claims operate as expected; filling in the Employer's name instead of the Primary's name as the subscriber. 

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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 as the subscriber (for example, in box 4 of the CMS 1500 form). The patient would then be listed as the employee as it is in this example on box 2. Check with the insurance carrier for any specific requirements. 
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The plan type is what controls which name is used as patient and subscriber. When using the Worker's Comp plan type, you may leave the account's primary guarantor in the Primary tab. Some offices may choose to enter the Employer as the primary person; however, it is not required for the claim information to print correctly. 

On the Primary/Secondary Tab, enter the employer and the employer's Worker's Compensation Insurance below. There is an 'Employers' section in the middle third of the Primary/Secondary Tab of the Patients Ability.
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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. 
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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 > Reason for Treatment > Condition Related To - This selection corresponds with boxes 10a  and 14 of the CMS form. Select that the condition is related to employment and enter an accident date. 
  • 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 > Claims > Disability > Partial or Total Disability Dates - This will pull into the claim to inform the insurance company of the dates the employee is unable to work. This corresponds with box 16 on the CMS form. 
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Any additional 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.

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