tci ED Coding & Reimbursement Alert - 2006 Issue 11

Reader Question: State Guidelines Govern Most Workers' Comp Claims

Question: I am unsure about a workers- compensation claim. The patient, a traveling business salesman, has insurance in New Jersey, but the injury occurred while he was on a work trip in Oregon. Whose billing rules should I follow for this claim: New Jersey-s, Oregon's or the federal government-s?Oregon Subscriber Answer: You-ll need to follow state rules when filing almost all workers- compensation claims. Each state has a unique set of rules, fee schedule, and setup for what providers the patient can see. As for which state's rules you should follow, focus on where the claim was first...

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