e-billing
California became one of the first three states in the country to provide for e-billing in workers’ compensation when medical treatment e-billing regulations became effective Oct. 18, 2012. Implementation of e-billing improves efficiency of the billing and remittance process and produces quicker bill payment.
By statute, claims administrators are required to accept electronic medical treatment bills. They may develop their own capacity to accept electronic bills or may contract with a vendor to perform the function. Participation in e-billing is optional for medical providers. A medical provider who chooses to submit paper bills must use the standardized paper billing forms and conform to the paper billing regulations.
Medical treatment providers – including hospitals, doctors, pharmacists, and others who provide medical services and goods to injured workers – are increasingly recognizing the benefits of using electronic standards to send their bills to payers. In turn, claims administrators who complete the cycle by processing and paying those bills electronically are seeing efficiencies from streamlined processes.
Electronic billing regulations and guides
Effective Oct. 1, 2015:
- Billing, second review, independent bill review regulations version version
- California Division of Workers’ Compensation Electronic Medical Billing and Payment Companion Guide version version
- California Division of Workers’ Compensation Medical Billing and Payment Guide
- California Division of Workers’ Compensation Medical Billing and Payment Guide (Rulemaking strikethrough/underline version)
Effective Feb. 12, 2014:
- Billing, second review, independent bill review regulations version version
- California Division of Workers’ Compensation Electronic Medical Billing and Payment Companion Guide version version
- California Division of Workers’ Compensation Medical Billing and Payment Guide
- California Division of Workers’ Compensation Medical Billing and Payment Guide (Rulemaking strikethrough/underline version)
Superseded Do Not Use:
Note: the revised versions of these superseded documents posted above contain the revisions related to the delay of ICD-10 implementation adopted Sept. 30, 2014. See rulemaking page for further detail. |
Effective Jan. 1, 2013:
- E-billing regulations; independent bill review regulations version version
- California Division of Workers’ Compensation Medical Billing and Payment Guide
- California Division of Workers’ Compensation Electronic Medical Billing and Payment Companion Guide version version
Effective Oct. 18, 2012:
- E-billing regulations - sections 9792.5.0 - 9792.5.3
- Medical Billing and Payment Guide 2011
- Excerpt of Medical Billing and Payment Guide - Table 1.0 California DWC Bill Adjustment Reason Code / CARC / RARC Matrix Crosswalk and Table 2.0 Matrix List in CARC Order versionversion
- Electronic Medical Billing and Payment Companion Guide 2012
Resources
- Frequently asked questions about e-billing
- Introduction to electronic medical billing / bill processing service providers
May 2016