When it comes to billing and insurance, we’re here to make it as simple as possible. At Pain Management Center, Inc., we aim to make the billing process as stress-free as possible. If you have questions about your payment options, our staff is here to help.
The billing procedure for workers’ comp consists of several phases, including filing the claim, patient treatment, and processing the claim.
Filing the Claim
Employees who are injured on the job typically file a claim through their employer’s workers’ comp carrier. The employee then receives a claim number after the claim is filed, which serves as an ID number when receiving reimbursement for the treatment. The workers’ comp carrier will also assign an adjuster, who will authorize the employee’s treatment, review the employee’s recovery, and coordinate the claims process. In some cases, the adjuster also authorizes the employee’s primary care provider to provide treatment or direct the employee to obtain treatment from the carrier’s provider network.
Once treatment has been authorized, the employee then becomes a patient. Services covered by workers’ comp aren’t billed to the patient or their private health insurance. If you are seeking treatment UNRELATED/IN ADDITION TO your worker’s compensation injury, please contact our office at 213-387-4710 to discuss further options.
Processing the Claim
At Pain Management Center, Inc., our billing department is highly trained in the electronic submission of the CMS-1500. The insurance billing department reviews the charges on the CMS-1500 and the attached progress notes to ensure the provided services are related to the work-related injury and authorized under the treatment plan.
Payment for unrelated and unauthorized services will be denied; the patient is not responsible for the payment of these treatments.
For questions regarding the Official Medical Fee Schedule (OMFS), please click here.