Missing claim number
Carrier rejects the bill because the compensation claim number or date of injury is absent. We capture both at intake, confirm compensability with the adjuster and hold the claim until the file is complete.
Home / Specialties / Occupational Medicine
Occupational medicine medical billing services
Occupational medicine billing serves three payers at once: workers' compensation carriers, employers paying directly for exams and screenings, and health plans for everything else. Each has its own forms, fee schedule and timeline, and a claim sent to the wrong one simply disappears. Collection depends on sorting the encounter correctly at check-in.
What makes occupational medicine billing different
Workers' compensation and employer services follow rules that have nothing to do with ordinary insurance, and most of them vary by state.
- Workers' compensation claims require the carrier claim number, date of injury and employer on the CMS-1500, pay under state fee schedules, and in states like New York and California must travel with the board's treatment and progress forms.
- Work-related evaluations by the treating provider bill 99455 and by a non-treating provider 99456, functional capacity testing bills 97750 per 15 minutes, and impairment ratings follow the state's adopted edition of the AMA guides.
- Employer-paid services such as pre-employment physicals, DOT exams, respirator clearance, audiometry 92551 or 92552, spirometry 94010 and drug screen collections are invoiced under the employer contract, not submitted as insurance claims.
- Injury diagnoses need an external cause code from the V through Y ranges and a Y99 work status code, and vaccines like Tdap 90715 and hepatitis B 90746 bill with administration 90471 to the employer or the plan.
Denials we see most in occupational medicine
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Fee schedule reduction
Bill review pays less than charged citing the state schedule or a network discount. We load each state's schedule, bill accordingly and dispute reductions that misapply ground rules.
Sent to the wrong payer
Employer exams submitted to a health plan, or work injuries billed to the patient's insurance. We classify every encounter at scheduling and route it to the carrier, the employer invoice or the plan.
How Core MB bills for occupational medicine
Core MB bills occupational medicine clinics with a team that works compensation carriers, employer accounts and health plans as three separate workflows, keeps state fee schedules and forms current and follows up with adjusters directly. Credentialing for new providers runs in the same client portal. Credentialing for new providers runs in the same system, tracked live in your client portal.
- Encounter type set at scheduling so compensation, employer and insurance work never cross streams.
- State fee schedules and required forms loaded per jurisdiction and attached before the bill goes out.
- Employer invoicing run monthly by contract with aging tracked separately from insurance AR.
Everything in the service
One team covering compensation claims, employer invoicing and insurance billing, with verification, coding review, scrubbing, adjuster follow-up, disputes, posting, reporting and credentialing included.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Occupational medicine billing questions
What happens when a work injury is denied as not compensable?
The carrier's denial shifts the encounter to the patient's health plan. We bill the health plan with the denial attached, since many plans will not pay a work-related claim without proof the carrier refused it, and we track the compensation dispute if the patient contests the denial.
Why is the carrier paying late or less than billed?
Workers' compensation bills go through bill review against the state fee schedule, and carriers have statutory payment windows that differ by state. We bill at the schedule, submit required forms with the first bill and file objections or board complaints when payment is reduced without a ground rule or runs past the deadline.
How do we bill a DOT physical for an employer that also wants a drug screen?
Both go on the employer invoice under the contract rate, never to insurance. We record the exam, the collection and any lab fees against the employer account, send the invoice on the agreed cycle and keep employer aging separate from insurance receivables.
How do we get started with Core MB for occupational medicine billing?
Send your states, employer accounts and monthly visit mix through the quote form and we will reply with a written proposal. Transitions run alongside your current billing so no carrier bill or employer invoice is dropped, and credentialing for new providers can start at the same time.
Three payers, one billing team that knows all of them
Core MB keeps compensation carriers, employer accounts and health plans each billed by their own rules so occupational medicine clinics collect on every encounter.