Conquer the Chaos of
Workers' Comp Billing
Workers' compensation is notoriously complex. We navigate aggressive claim adjusters, strict state fee schedules, and Utilization Review (UR) processes to ensure you are paid fully for treating injured workers.
UR & RFA Mastery
We proactively manage Requests for Authorization (RFA) and Utilization Review (UR) deadlines so your treatments are approved before they are performed.
Why Workers' Comp Demands Tenacious Billers
General medical billers fail at Workers' Compensation because they expect claims to process automatically. Work comp requires relentless follow-up with insurance adjusters, deep knowledge of state-specific fee schedules, and the ability to link every CPT code directly to the authorized work injury. We provide the aggressive follow-through required to get you paid.
State Fee Schedule Mastery
We map your billed CPT codes directly against the specific state’s official medical fee schedule (OMFS) to ensure you are never underpaid by aggressive insurance carriers.
PR-2 & Narrative Reporting
Work comp claims are denied instantly without medical records. We electronically attach Primary Treating Physician’s Progress Reports (PR-2) and operative notes to every submitted claim.
IME & QME Billing
We handle the specialized billing rules for Independent Medical Examinations (IME) and Qualified Medical Evaluators (QME), ensuring you are compensated for complex medical-legal reports.
Securing Revenue from
First Report to Final Payout
We manage the heavy administrative burden of Workers' Comp, ensuring all paperwork, causation reports, and authorizations are perfectly aligned before the claim drops.
Injury & Employer Auth
Before the first visit, we verify the specific date of injury, the accepted body parts, and obtain the initial authorization directly from the employer or insurance carrier.
Utilization Review (RFA)
We submit Requests for Authorization (RFA) for surgeries, physical therapy, or diagnostics, tracking the UR timeline meticulously to prevent unauthorized care denials.
Causation Coding
We audit clinical notes to ensure ICD-10 diagnosis codes are strictly related to the accepted work injury, preventing payers from denying claims as "non-industrial."
Adjuster Negotiations
Unlike standard payers, work comp requires picking up the phone. Our team actively calls claim adjusters to push through delayed payments and file formal Second Bill Reviews (SBRs).
Stop Losing Money to
Adjuster Delays & Denials
Partner with a team that fights for your revenue. We understand state fee schedules, UR appeals, and how to negotiate with workers' comp adjusters. Contact Valeria Healthcare Solutions today.