RESTON, VA – As much as the healthcare industry is trying to move to electronic data interchange, handling workers’ compensation bills is often like a trip down memory lane.
Much of the process of settling injured workers’ medical care remains locked in a paper world. For care providers, they typically need two sets of approaches – an electronic one for most claims, and a ready supply of paper for workers’ compensation.
However, that’s changing. On January 1, Texas enacted a law requiring the use of electronic billing for workers’ compensation cases. The state is the first in the country to mandate electronic billing. Other states have similar laws in the pipeline, and more are watching the Lone Star State’s experience.
A standards organization and other industry groups are making a pre-emptive strike by trying to ensure that all state initiatives rely on standards so that electronic billing is the same from one state to the next.
The Workgroup for Electronic Data Interchange has formed a Workers’ Compensation subgroup to coordinate the use of standards in this area. Also playing a vital role in the effort is the International Association of Industrial Accident Boards and Commissions, which has launched an electronic data interchange project.
“We’re saying, ‘Let’s not do one for each state and end up with 50 different approaches,’” said Jim Wicker, who works at Intermountain Healthcare and co-chairs WEDI’s subgroup. “Let’s get them together and talk about what the issues are and work out the differences so we have just one.”
Workers’ compensation is slow to come along because typical cases involve a number of parties – the employer, the employee injured on the job, the insurance company, government agencies and all involved care providers. Typical communications include first report of injury, subsequent report of injury, proof of coverage and medical expense payment.
While some payers can electronically communicate in reimbursing for workers’ compensation care, most cannot, said Deborah Meisner, vice president of e-service compliance for Nashville, Tenn.-based Emdeon Business Services and an active WEDI member in workers’ compensation issues.
Small regional payers that specialize in workers’ compensation and self-funded plans still depend heavily on paper, Meisner said.
Texas’ experience has gone as well as could be expected in the first three months, said Allen McDonald, director of information management services for the Division of Workers’ Compensation in the state’s department of insurance.
“The whole goal is to eliminate the administrative hassle, the time providers have to spend to input everything and then send it on paper to the carrier, who has to input all the same stuff again,” McDonald said. “Things can go a lot quicker and smoother electronically.”
“One of the big problems we’ve experienced is connectivity,” he said. “Even though carriers have built systems to receive bills and providers are able to send them, the workers’ compensation has been slow to execute data sharing agreements.”
Moving to a standards-based approach won’t be easy. For example, workers’ compensation bills typically include a lot of documentation, and the X12N standard for attachments hasn’t been implemented yet as a HIPAA-required transaction, Meisner said.
States typically have developed specific requirements and approaches for workers’ comp, Wicker said. For example, if a worker’s claim is denied, states require specific responses.