Workers’ Compensation & Auto
Overview
In August of 1993 Pennsylvania enacted a new law governing how workers’ compensation claims were to be billed by medical providers and paid by insurance companies. These process changes also required changes to a provider’s billing, payment verification and dispute resolution processes. Many providers have not adequately adjusted to these changes and workers’ compensation claims have since become the most difficult to bill, manage and collect.
Our Workers' compensation & auto Services:
our role
Fortunately, SunStone can help. We have unparalleled experience and expertise in this area. Tim Mosco, our service line leader for Workers’ Compensation & Auto services, worked directly with the Bureau of Workers’ Compensation in writing the supporting regulations, developing the processes for the Bureau’s Application for Fee Review system and training of Fee Review staff. With Tim’s leadership we have been providing workers’ compensation consulting, claims-related assistance and outsourcing for over twenty years.
Hospitals that outsource their Workers’ Compensation & Auto billing and recovery to vendors without extensive experience in Pennsylvania guidelines and regulations run significant risk of not being paid promptly, completely and in compliance. Many firms use generic billing and recovery processes that just do not work for Workers’ Compensation & Auto claims. No other state has processes and regulations as unique as Pennsylvania’s. Our team is trained specifically for Workers’ Compensation & Auto billing and reimbursement, and our process is intensive and comprehensive.
Our Process
Prior to billing any claim, our team will do the following:
Verify the claim details with the employer.
Compile all of the required billing documents.
Submit billing documents and follow up if no payment or denial is received.
If needed, use the Application for Fee Review process within the required time.
The benefits you will gain from our services include:
Ability to re-assign staff to other functions.
Greatly improve the efficiency and collections of workers’ compensation payments.
Increase workers’ compensation revenue by 5% on average, net of our fees.
Outsourcing your Workers’ Compensation & Auto billing and collections to SunStone, the best in the business, is a smart move!
What our clients say
“Pennsylvania’s Workers’ Compensation reimbursement is uniquely complicated and difficult to manage. SunStone’s long history and deep knowledge of this environment have been invaluable as our outsource partner to make sure we get paid everything we are due by effectively managing all aspects of the billing, collections, fee reviews and CDM updates.”
– Chris Stottlemeyer, Senior Director, WellSpan Health