Workers Compensation Services
Our nations healthcare system encourages providers and injured employees to work together to provide quality care and expedite reimbursement. However, governing laws and nuances are frequently not transparent to effected parties, thereby resulting in potentially incorrect reimbursements. GRANT & WEBER ensures that providers receive the appropriate compensated for services rendered to injured workers.
Our goal is to ensure that each bill meets clean claim guidelines, has the correct billing amount for services rendered, includes accurate coding and billing, and is sent to the correct payers with all supporting documentation.
A denied claim or a denied treatment does not mean the provider does not receive payment. Workers’ Compensation Denial Management specialists are responsible for filing reconsideration appeals or initiate bill review for claims that received a denial. Our specialists are highly skilled at problem solving and negotiating a timely resolution on denied claims, positively impacting bottom lines.
Planning, human expertise and technology combined together swiftly and efficiently identifies underpayments. Our comprehensive approach to closed or zero balance methodologies reconciles inaccurate financial transactions. Account reconciliation includes written or verbal communication with the payer, employer or guarantor. Once an account has been reconciled, assessment for follow-up will be strategized and engaged appropriately.
Our specialists are responsible for reviewing claims before timely filing deadlines to ensure maximum reimbursement of workers’ compensation claims. Identifying underpayments for paid claims, advising clients of silent PPO concerns are delivery service routines.
Legal management often differs from state to state. For example, in California GRANT & WEBER stands in the forefront in litigating before the Workers’ Compensation Appeals Board (WCAB) to get medical providers the monies they are entitled. We stand ready to litigate on your behalf when necessary to collect the total amount rightfully due to your organization. Our in-house legal staff is a value added service that controls cost, provides legal advice and makes litigating smaller-balance accounts more cost-effective, significantly enhancing your rate of recovery. In some states, like Texas, our legal management is responsible for filing a Medical Fee Dispute for claims denied for reimbursement reasons, or a Benefit Review Conference for claims denied for a claim related reason, or request an Independent Review Organization for claims denied for medical necessity. Reimbursable claims not fully adjudicated will continue in the legal process by filing appeals with the District Court State Office of Administrative Hearings (SOAH) by submitting any additional proof, evidence or arguments in order to obtain a favorable decision.